Patent Ductos Arteriosus In Children

GENERAL INFORMATION:

What is it?

• Patent Ductus Arteriosus (r-teer-e-O-sus) is also called a "PDA." It is a channel or path that connects two large arteries that come out of the top of the heart. The two arteries are called the aorta and the pulmonary artery.
  
  
• Before a baby is born, the PDA is called a Ductus Arteriosus or "DA." The DA is important because it causes most of the blood to bypass the baby's lungs. The lungs do not need much blood since unborn babies do not breathe air. The placenta acts like a lung for unborn babies.
  
  
• After birth, babies do not need the DA anymore because they need to have blood going to their lungs. The DA is supposed to close shortly after birth. A DA that does not close after birth is called a PDA. A PDA can cause heart problems.

How does the heart normally work?

• The heart has four chambers. The two upper chambers are called the right and left atria (A-tree-uh). The two lower chambers are the right and left ventricles (VEN-trik-ulls). Veins bring blood from the body to the right atrium. The right atrium sends blood down to the right ventricle. Blood goes from the right ventricle into the pulmonary artery and into the lungs.
  
  
• In the lungs, blood gets rid of waste and fills up with oxygen. The oxygen rich blood goes back to the heart through the left atrium and into the left ventricle. The left ventricle pumps blood out of the heart into the aorta. The aorta takes oxygen rich blood to the rest of the body.

What happens if your child has a PDA?

• After birth, a PDA causes some of the blood from the aorta to leak back into the pulmonary artery. This is not supposed to happen since the blood from the aorta has just come through the lungs. The circling or back flow of blood caused by the PDA makes extra work for the heart and lungs. The heart has to pump harder than normal to send enough blood and oxygen out to the body.
  
  
• In time, even more blood may move through the PDA. Blood that has not yet been to the lungs for oxygen is sent out to the body. The heart cannot keep working so hard. Blood and fluid build up in the lungs. Pumping the extra load of blood and fluid can make the heart wear out. This is called congestive (kun-JES-tiv) heart failure.

Causes: A PDA is supposed to close by constricting (squeezing itself off). After your child was born, your child's PDA did not constrict. PDAs happen more often in premature babies (babies born too early). It also happens more in girls than boys and in babies born at high altitudes. PDAs also happen often in babies whose mothers had rubella (rew-BELL-uh) during pregnancy.

Signs and Symptoms: Some people have no symptoms because their PDA opening is very small. Your child may have one or more of the following signs or symptoms:

• Heart murmur (extra sound) when caregivers listen to your child's heartbeat.
  
  
• Shortness of breath after crying, eating, or being active.
  
  
• Difficult or labored (hard, fast) breathing at rest.
  
  
• Lips and fingernails turn blue after crying, eating, or being active.
  
  
• Pounding pulses that can be seen through the skin and felt.
  
  
• Problems eating and gaining weight.
  
  
• Frequent colds and lung problems.
  
  
• Fingers and toes may become round and thick. This is called "clubbing." Clubbing usually goes away once the PDA has been repaired.
  
  
• Sweating.

Tests: Usually a PDA is found early in life. Sometimes the PDA is very small and is not noticed until your child has grown. The following tests may be done to learn if your baby or child has a PDA. Some of the test results may be normal if the PDA is small.

• Chest X-ray: This is a picture of your child's lungs and heart. Caregivers use it to see if the heart chambers are larger than they should be. A chest x-ray can also show if the aorta and the pulmonary arteries have gotten larger.
  
  
• 12 Lead EKG: This test helps caregivers see if there are problems caused by the left side of the heart getting larger. Sticky pads (10) are placed on your child's chest, arms, and legs. Each pad has a wire that is hooked to a machine. This machine prints a paper tracing of your child's heart beat. This test is painless and takes about 5 to 10 minutes.
  
  
• Echocardiogram:
  
  
  • An echocardiogram is often called an "echo." Sound waves are used to show pictures of the size and shape of your child's heart. It also looks at how your child's heart moves when it is beating. These pictures can be seen on a TV-like screen. This painless test is done while your child is lying down on his side.
    
    
  • The echo is done in a quiet area with the lights turned off. Clear gel will be used so the echo probe can be rubbed easily across your child's chest to get a good picture. The clear gel will be cleaned off after the test. This test can show how well your child's heart is pumping. An echo can also find problems such as fluid around the heart or problems with your child's heart valves.
  
  
• Cardiac Catheterization: Cardiac catheterization (kath-uh-ter-ih-ZA-shun) is a test used to see how well your child's heart is working. Your child's heart valves are checked to see how well they open and close. Your caregiver may also measure the pressure inside your child's heart. A cardiac cath may also show how much blood is moving through the PDA. A special tube is threaded into your child's heart through a blood vessel in the leg or arm. Dye may be given so x-ray pictures of your child's arteries show up better on a TV-like screen.

Treatment: Your child's PDA may not be treated if it is not causing heart problems. This is because your doctor may want to see if the PDA will close on its own. If a PDA does not close on its own by about age 2, the doctor may want to close it. Closing the PDA is important even if there are no symptoms. There is a greater risk of endocarditis (end-o-kar-DI-tis) as your child grows older if the PDA is not closed. Endocarditis is a serious infection of the heart muscle. One or more of the following treatments may be used to treat your child's PDA.

• Medicine:
  
  
  • If your baby is premature, your baby's doctor may want to close the PDA with medicine. The medicine is given through an IV. It is called a prostaglandin (prah-stuh-GLAN-den) inhibitor. Surgery may not be needed if this medicine works and closes the PDA.
    
    
  • If the PDA is causing heart problems, your child's doctor may give your child heart or water pills. These medicines may help your child's heart to work better.
    
    
  • If your child is older, your child may need antibiotics (an-ti-bi-AH-tiks) before having dental care or other procedures. Taking antibiotics first may help prevent a serious infection of the heart called bacterial (bak-TEER-e-ull) endocarditis (end-o-kar-DI-tis). Do not stop giving your child antibiotics until they are all gone.
  
  
• Surgery:
  
  
  • Surgery to close the PDA is called PDA Ligation (lie-GAY-shun) or Division (dih-VIH-shun). The surgeon will make an incision (cut) between the ribs on your child's left side. The PDA is closed with stitches (thread) or small metal clips. This surgery is often done on premature babies whose PDAs did not close after using prostaglandin inhibitor medicine. Ask your caregiver for the CareNotes™ handout on PDA Ligation.
    
    
  • Visual-Assisted Thoracoscopic Surgery is also called "VATS." The surgeon doing VATS makes four tiny incisions (cuts) between the ribs on your child's left side. The surgeon uses cameras and probes to clamp shut the PDA. Ask your caregiver if this type of treatment is possible for your child's PDA.
  
  
• Transcatheter Coil Occlusion: This is a way to close your child's PDA without surgery. During a cardiac catheterization, one or more tiny coils may be plugged into the PDA to close it. This is usually a treatment for bigger babies and older children. Ask your caregiver for the CareNotes™ handout on this procedure.

Call if your child has: If your child is sent home from the hospital with a PDA, these are some things to watch for. Call your doctor if any of the following problems happen:

• Problems eating and gaining weight.
  
  
• Difficult or labored breathing.
  
  
• Shortness of breath after crying hard, eating, or being active.
  
  
• Lips and fingernails turn blue with activity.
  
  
• A temperature of 100.4°F (38°C) or more.
  
  
• Chills, a cough, or your child feels weak and achy. These are signs that your child may have an infection.
  
  
• Itchy, swollen skin, or a rash. This may mean that your baby is allergic (uh-LER-jik) to his medicine.
  
  
• You have questions or concerns about your child's PDA or medicine.

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

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