Overview

What Is Patent Ductus Arteriosus ?

Patent ductus arteriosus (PDA) is a Congenital defect in which the temporary blood vessel connecting the left pulmonary artery to the aorta in the fetal heart fails to close after birth. In the fetal heart, blood bypasses the lungs and gets oxygen from the placenta. But when the newborn's lungs take over at birth, the body stops producing the chemicals that keep the ductus arteriosus open, and it closes naturally.

If the ductus arteriosus fails to close completely, the baby has PDA. While this problem is rare, it is sometimes associated with mothers who have had German measles (rubella) during pregnancy and with infants born before their due date (prematurely). The result of this defect is that too much blood travels to the lungs. The severity of the problem depends on how large the opening is and how prematurely the baby was born.


PAD is similar to coronary artery disease, which affects arteries that supply blood to the heart (coronary arteries), and carotid artery disease, which affects arteries that supply blood to the brain (carotid arteries). The term "peripheral" means "occurring away from the center." Peripheral artery disease often causes pain, difficulty walking, and sores on the skin that do not heal normally.

Signs and Symptoms :

Signs of peripheral artery disease include absent or weak pulse, decreased blood pressure, and arterial bruits (sounds heard using a stethoscope) in the affected limb. In many cases, the condition is asymptomatic (i.e., does not cause symptoms). Signs and symptoms of PAD usually affect only one limb or are more severe in one leg than the other

Common symptoms of PAD include muscle pain, difficulty walking, and sores (ulcers) that do not heal normally. Other symptoms include numbness, tingling, and muscle cramps that often occur at rest, variations in skin temperature and color (e.g., feeling cold, pale or bluish coloring [called cyanosis]), and hair loss or poor nail growth in the affected limb. These symptoms result from inadequate blood flow (circulation).

Pain caused by PAD usually worsens with activity (e.g., walking) and improves with rest. It occurs when muscles do not receive an adequate supply of blood. This pain is called intermittent claudication. "Intermittent" means coming and going or ceasing from time to time, and the term "claudication" comes from a Latin word that means "to limp." Intermittent claudication often leads to limping or other changes in walking manner (gait). In severe cases, peripheral artery disease causes pain that continues even during periods of inactivity.

Treatment :

The goals of PAD treatment are to reduce symptoms and prevent the condition from worsening or progressing. Treatment usually includes lifestyle changes, regular exercise, and medications.In severe cases that do not respond to conservative PAD treatment, surgery may be necessary

Patients who have peripheral artery disease should not smoke. In patients with PAD, people who smoke typically develop symptoms 10 years earlier than non-smokers. Smoking also increases the risk for heart attack and stroke even further

Regular exercise is one of the most effective treatments for PAD. Exercise programs, which should be supervised by a physician, often include walking and leg exercises. Patients often are encouraged to alternate periods of activity with periods of rest to slowly increase the amount of time they are able to exercise without pain. In some cases, exercise is monitored in a rehabilitation center. In patients who have peripheral artery disease, regular exercise can help improve circulation over time because it helps to promote the growth of new peripheral arteries (called collateral blood vessels).

In addition to regular exercise, other lifestyle changes that may be helpful include maintaining a healthy weight and eating a diet low in fat (especially saturated fat), cholesterol, and sodium (salt). Patients often are encouraged to eat plenty of fruits and vegetables and low-fat dairy products (e.g., skim milk).

PAD treatment often requires medication to control medical conditions that contribute to the condition, such as diabetes, high blood pressure, and high cholesterol. Insulin may be used to control blood glucose (sugar) levels in patients who have diabetes.


Specific treatment for PDA will be determined by your child's physician based on : -

your child's age, overall health, and medical history
extent of the disease
your child's tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

A small patent ductus arteriosus may close spontaneously as your child grows. A PDA that causes symptoms will require medical management, and possibly even surgical repair. Your child's cardiologist will check periodically to see whether the PDA is closing on its own. If a PDA does not close on its own, it will be repaired to prevent lung problems that will develop from long-time exposure to extra blood flow.

Complications :

Peripheral artery disease increases the risk for heart attack, stroke (brain attack), transient ischemic attack (TIA; "mini stroke"), and other serious complications. The risk for complications is higher in patients who have uncontrolled diabetes, high blood pressure, high cholesterol, or severe kidney disease.


PAD complications include the following :

Blood clots
Erectile dysfunction (impotence)
Infection
Open sores on the skin (ulcers) that do not heal
Pulmonary embolism (blood clot that travels to the lungs)

When blood flow (circulation) is severely reduced, a condition called ischemia results. Ischemia increases the risk for infections that can lead to gangrene (tissue death and decay). Gangrene often requires amputation (surgical removal) of the affected limb.


What Causes Patent Ductus Arteriosus ?

The cause of patent ductus arteriosus (PDA) is not known. Genetics may play a role. A defect in one or more genes could prevent the ductus arteriosus from closing normally after birth.

PDA is more common in : -

Premature infants (babies born too early)
Infants with genetic abnormalities such as Down syndrome
Infants whose mother had German measles (rubella) during pregnancy


What Are the Signs and Symptoms of Patent Ductus Arteriosus ?

A heart murmur may be the only sign that a baby has patent ductus arteriosus (PDA). A heart murmur is an extra or unusual sound heard during the heartbeat.

Some infants may develop signs or symptoms of volume overload on the heart and excess blood flow in the lungs.


How Is Patent Ductus Arteriosus Diagnosed ?

In full-term infants, a patent ductus arteriosus (PDA) usually is first suspected when the baby's doctor hears a heart murmur during a regular checkup. If a PDA is large, the infant may also develop symptoms of volume overload and increased blood flow to the lungs. When a PDA is small, it may not be diagnosed until later in childhood. Once a PDA is suspected, a consultation with a pediatric cardiologist will be arranged. A pediatric cardiologist is a doctor who specializes in diagnosing and treating heart problems in children.

In premature babies (babies born too early) with PDA, the physical signs that are seen in full-term babies, such as heart murmur, may not be present. Doctors may suspect a PDA in premature babies who develop breathing difficulties soon after birth. Doctors use tests such as echocardiography to look for PDA in premature babies with breathing problems.

PDA repair or closure in India :

The majority of infants and children with PDA are candidates for repair in the cardiac cath lab. The goal is to repair the PDA before the lungs become diseased from too much blood flow and pressure.

Repair is usually indicated in infants younger than 6 months of age who have large defects that are causing symptoms, such as poor weight gain and rapid breathing. For infants who do not exhibit symptoms, the repair may often be delayed until after 6 months of age. Your child's cardiologist will recommend when the repair should be performed.

Transcatheter coil closure of the PDA is frequently used because it is minimally invasive. However, premature infants are not candidates for this procedure.

Your child's PDA may be repaired surgically in the operating room. The surgical repair, also called PDA ligation, is performed under general anesthesia. The procedure involves closing the open PDA with stitches to prevent the surplus blood from entering your child's lungs. Alternately, the vessel connecting the aorta and pulmonary artery may be cut and cauterized (sealed off by burning with an electrical instrument).

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