Patent ductus arteriosus (PDA) is a condition when the blood vessels that connect the aorta and pulmonary arteries remain open after the baby is born. PDA is a type of congenital heart defectwhich is usually experienced by premature babies.
While in the womb, the baby does not need the lungs to breathe because it already gets oxygen from the placenta (placenta). Therefore, most of the blood that will go to the lungs is diverted throughout the body through the lungs ductus arteriosus.
Ductus arteriosus is a blood vessel that connects the aorta (the vessel that carries oxygen-rich blood from the heart to the rest of the body) and the pulmonary artery (the vessel that carries blood from the heart to the lungs).
This channel should close automatically within 2-3 days after birth, because the baby's lungs have started working to replenish the oxygenated blood. However, on patent ductus arteriosus, this channel remains open. As a result, the blood in patients with PDA becomes deprived of oxygen.
Causes and Risk Factors of Patent Ductus Arteriosus
Until now it is not known exactly what causes PDA. However, there are a number of factors that are thought to increase the risk of a baby developing this condition, namely:
- Female genderPDA is 2 times more common in girls than boys.
- Rubella infection in pregnant womenThe rubella virus in the womb can spread to the baby's respiratory system and then damage the heart and blood vessels.
- Born in the highlandsThe risk of developing PDA is higher in babies born in areas with an altitude of more than 2500 meters above sea level.
- Disease historyBabies born to families with a history of heart problems or babies who have certain genetic disorders, such as Down's syndrome, are more at risk of developing PDA.
- Born prematurely
The lower the gestational age at birth, the greater the chance of developing PDA. More than 50% of premature babies born at less than 26 weeks and about 15% of babies born at 30 weeks have PDA.
Symptoms of patent ductus arteriosus
Symptoms of PDA depend on size ductus arteriosus which is open. PDAs with small openings sometimes do not cause any symptoms, even into adulthood. However, a PDA with a wide opening can cause heart failure in the baby shortly after the baby is born.
Some of the symptoms of a wide-open PDA include:
- Tired easily
- Breastfeeding is not smooth (often stops in the middle)
- Sweating while eating or crying
- Fast breathing or shortness of breath
- Heart beating fast
- Difficult to gain weight
When to go to the doctor
Check with the doctor if your child shows the above complaints. Also, watch for signs of shortness of breath in babies, such as:
- fast breath
- The part under or between the ribs as if pulled in when breathing
- Nostrils that inflate when you breathe
- A whistling sound appears when the baby breathes
Immediately take the child to the ER if he shows the above signs.
Diagnosis of patent ductus arteriosus
Doctors can diagnose PDA by listening to the baby's heartbeat through a stethoscope. The heart of a baby with PDA generally makes a loud noise when it beats. Several further tests can also be done to confirm the diagnosis, such as:
Echocardiography
This examination uses sound waves to produce a detailed picture of the heart. Through echocardiography, doctors can determine the ability of the heart to pump blood and blood flow in the heart, including abnormal blood flow that occurs in PDA.
Electrocardiography (ECG)
This examination can show abnormalities in the size of the heart muscle and heart rhythm disturbances.
Chest X-ray
This examination will help the doctor see the condition of the baby's lungs and heart.
Patent Ductus Arteriosus Treatment
Baby with opening ductus arteriosus which are relatively small do not require treatment. This is because PDA openings generally close by themselves as they age. Doctors will only recommend regular checkups to monitor the baby's condition.
Treatment will be suggested when opening ductus arteriosus does not close by itself or if the opening is large. Available treatment methods include:
Drugs
For cases of PDA in premature babies, doctors may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and indomethacin. This medicine can help close the opening ductus arteriosus. However, PDA in term infants, children, or adults cannot be treated with this drug.
Installation of plugs
In term babies or toddlers and adults who still have a small PDA opening, the doctor will install a plug device. In this procedure, the doctor will first insert a catheter (cardiac catheterization procedure) into the blood vessels of the heart through the groin.
After that, the doctor will insert a plug device through the catheter to be placed in the opening ductus arteriosus. Through this action, blood flow will return to normal.
Surgery
For a PDA with a wide opening, the doctor will suggest a surgical procedure. Generally, this procedure is performed on infants aged 6 months and over. However, surgery can also be applied to infants aged 6 months and under who experience symptoms.
Surgery is performed by making an incision between the baby's ribs. After that, the doctor will close the opening using clips or stitches. To prevent infection after surgery, the doctor will prescribe antibiotics.
Complications of Patent Ductus Arteriosus
A wide-opening PDA that is not treated promptly can lead to the following complications:
- Heart failurePDA can cause the heart to enlarge and weaken, so that over time it can lead to heart failure.
- Pulmonary hypertensionPulmonary hypertension is high blood pressure in the blood vessels of the lungs which can cause permanent damage to the lungs and heart.
- Heart infection (endocarditis)People who have a PDA are more at risk of developing endocarditis or inflammation of the inner lining of the heart (endocardium).
Prevention of patent ductus arteriosus
Patent ductus arteriosus cannot always be prevented. However, there are several ways that pregnant women can do to reduce the risk of their baby developing this disease, namely:
- Eating nutrient-rich foods, including vitamin supplements containing folic acid
- Avoid cigarettes, alcoholic beverages, and drugs
- Get vaccinated before pregnancy to prevent infection
- Keeping blood sugar levels under control
- Manage stress well
- Exercise regularly