Patent ductus arteriosus

Patent ductus arteriosus (PDA) is a congenital cardiac condition that gives rise to tachycardia and breathing problems, apart from other physical difficulties.

What is Patent ductus arteriosus?

It is a condition that is characterized by non-closure of the Ductus arteriosus, a small blood capillary in the fetus that joins the pulmonary artery to the aorta.

Patent ductus arteriosus ICD 9 Code

The ICD 9 Code for this disorder is 747.0.

Patent ductus arteriosus Incidence

The probable incidence of this condition ranges anywhere from 6 to 20 in every 100,000 full term infants. It usually affects girls two times more than boys. However, it affects both boys and girls equally in case of Congenital Rubella Syndrome.

Patent ductus arteriosus Symptoms

Some cases of the disorder do not give rise to any symptoms while many individuals with PDA commonly exhibit problems like:

• Breathing problems
• Tachycardia
• Persistent heart murmur
• Shortness of breath (Dyspnea)
• Left subclavicular thrill
• Bounding pulse
• Enlarged heart (Cardiomegaly)
• Widened pulse pressure
• Differential Cyanosis
• Poor growth

The signs and symptoms of PDA tend to vary with the size of the abnormality as well as the gestational age of a suffering newborn. A small defect usually goes undetected until adulthood, as it does not give rise to any difficulties. However, a large PDA can lead to symptoms of cardiac failure right after birth. A large defect during childhood or infancy itself, may give rise to symptoms like:

• Fatigue, even with little activity
• Poor food intake
• Poor growth
• Sweating, while eating or crying
• Breathlessness or constant rapid breathing
• Dusky or bluish skin tone

Patent ductus arteriosus Causes

The Ductus arteriosus is a vital part of the circulatory system of a baby before birth. While a baby is in its mother’s womb, this blood vessel diverts the blood supplied to the fetus by the lungs, while it is not being used. The fetus receives oxygen from the circulation of the mother. In normal cases, this blood vessel generally closes soon after a baby is born. In PDA infants, however, it remains open which is why it is referred to as Patent. The condition is thus known by the name Patent ductus arteriosus.

This abnormal aperture leads to the circulation of too much blood to the heart and the lungs. Unless treated in time, there can be a buildup of blood pressure within the lungs (Pulmonary Hypertension). This can lead to an enlargement and weakening of the heart.

It is not known what exactly leads to the persistent opening of the Ductus arteriosus. It is generally regarded as a congenital defect and is thus, considered to be a result of hereditary factors. However, environmental factors are also believed to play a role in the development of PDA.

Patent ductus arteriosus Diagnosis

The condition is generally detected when a heart defect is suspected by a physician while listening to the cardiac rhythm of a baby during regular checkup. As aforementioned, the condition can lead to a heart murmur. A doctor can hear this abnormal sound with the aid of a stethoscope. If a physician hears this sound and detects other symptoms of PDA, he or she may recommend medical tests like:

Echocardiogram

The test involves use of audio waves to create images of the heart, which can help physicians detect a defect characteristic of PDA. The images can also help physicians to check possible enlargement in the cardiac chambers and determine the efficiency of the heart in pumping blood. Doctors can also analyze the condition of the heart valves and seek any other cardiac defect.

Electrocardiogram (ECG)

It records the electrical activity of the cardiac chambers and detects heart defects or problems in heart rhythm.

Chest X-ray

An X-ray image of the chest helps physicians determine the condition of the heart and lungs of an infant. It may also help identify conditions apart from a cardiac defect.

Cardiac catheterization

It is not necessary for diagnosis of a PDA only. However, it may be carried out to analyze other congenital heart conditions detected during an echocardiogram. In this exam, a flexible, thin-shaped tube (known as catheter) is inserted into a blood vessel at the arm or groin of an infant and pushed into the heart. Doctors can use the process to close the cardiac defect.

Imaging examination

Magnetic Resonance Imaging (MRI) or Cardiac Computerized Tomography (CT) can be used to detect cardiac problems, generally in adults. PDA might be accidentally discovered when a MRI or CT scan is performed for some other reason. During the CT scan of the heart, patients must lie on a table while an X-ray tube rotates around the body and captures images of the chest and heart.

During a cardiac MRI, patients have to lie on a table within a tubular machine that creates a magnetic field. This field helps adjust atomic particles in some of the cells. When radio waves are transmitted in the direction of these aligned particles, they give rise to signals that differ on the basis of the type of tissue. These signals produce images of the heart which helps physicians detect problems in the cardiac region.

Patent ductus arteriosus Treatment

The treatment for this disorder depends on the age of patients who are going to be cured. Medical cure usually involves:

Careful monitoring

In premature babies, PDA often eventually closes naturally. During the initial weeks, doctors carefully monitor the heart of an affected baby to confirm that the open blood vessel has properly closed. In full-term babies as well as young children and adults who do not exhibit any other problems than a small PDA, physicians might simply recommend supervising the condition without using any medical procedures to shut the PDA.

Medicines

In premature babies with the problem, doctors might simply recommend using Non-steroidal Anti-Inflammatory Drugs (NSAIDs) like Indomethacin (Indocin) or ibuprofen (such as Motrin or Advil). NSAIDs obstruct the chemicals in the human body that keep the PDA open. However, such medications are unsuccessful in closing a PDA in full-term babies, young kids or adults.

Open-heart surgery

This operative process might be recommended if medications fail to shut the PDA and an affected baby develops other health issues. The technique involves making a tiny incision between the ribs of a child to help surgeons get access to the heart and use clips or stitches to repair the open duct. Following surgery, the patient has to remain in hospital for a few days under medical observation. An affected child usually takes several weeks to make a complete recovery.

Adults who have a PDA, that gives rise to health problems, may also be recommended this surgical procedure. Hoarseness, infection, bleeding and a paralyzed diaphragm are some of the possible risks of using this technique.

Catheter

These are usually recommended only in babies who are at least 1 year old. The process involves introducing a thin tubular structure known as catheter into a blood vessel located in the groin. This is pushed up to the heart and a coil or plug is inserted to shut the ductus arteriosus. The technique might be performed on an outpatient basis, which indicates that a child might not require an overnight stay in the hospital. Although the process is less invasive as compared to open-heart surgeries, they can give rise to complications like infection, bleeding or movement of the coil or plug from its original position in the heart.

Patent ductus arteriosus in Children

Although premature babies commonly suffer from this condition, it is rare in full-term infants. Every year, PDA is diagnosed in approximately 3,000 infants in the U.S alone. Girls are 2-3 times likelier to suffer from this disease than guys. The condition is found to be more common in babies suffering from Down’s syndrome or having mothers who suffered from German measles (Rubella) during pregnancy.

In babies having a normal ductus that is shutting but suffering from other types of cardiac defects like pulmonary atresia, interrupted aortic arch or hypoplastic left heart syndrome, physicians may use medications like Prostaglandin to keep the ducts exposed. Keeping the ducts open help blood flow through the heart until the other problems can be cured.

Patent ductus arteriosus in Dogs

In dogs, PDA is the second most common congenital cardiac defect. Around 7 out of every 1000 live births in dogs are said to be affected by this heart condition. Unless congestive heart failure leads to an accumulation of fluids in the lungs of canines, no serious complications are observed. In certain cases, affected puppies are found to be smaller than normal and play with less energy. However, the symptoms usually manifest within a year of diagnosis of the disease. This cardiac defect is generally detected during a routine visit when a puppy is taken to a vet for vaccination.

Dogs with PDA usually exhibit problems like:

• Coughing
• Respiratory difficulties
• Intolerance to exercise
• Fatigue

If left uncured, the condition can be life-threatening. Approximately 60% puppies are found to die within a year of diagnosis in cases where treatment is not sought in time.

Patent ductus arteriosus Prognosis

The outcome of the disorder varies, depending on the age as well as the health condition of a sufferer. There is risk of Bronchopulmonary Dysplasia in premature infants with acute PDA. The prognosis is likely to be a bad one in cases where Respiratory Distress Syndrome (RDS) is found to co-exist with the condition. However, in most cases where closure of the ductus has been found to be surgically successful patients have not been found to suffer from any more complications.

Patent ductus arteriosus Prevention

There is no specific way to prevent the condition as its cause is unclear. However, a healthy pregnancy is believed to help avoid such problems. Naturally, it is essential to follow every possible measure that increases chances of a healthy pregnancy. These include:

Seeking early prenatal care

Getting prenatal care on an early basis can help you ensure the health of yourself as well as that of your child. Talk to your doctor about your possible smoking habits and any medications that you are taking. Try to know about ways that can help you reduce stress.

Working out regularly

Regular exercise in low intensity can help keep your metabolism functioning in a proper way. Consult your doctor about a workout plan that is best suited for you in pregnancy.

Having a balanced diet

Restrict intake of caffeine and junk foods. Add nutritious foods that are rich in vitamins and minerals and also include a vitamin supplement that comprises of Folic acid. Talk to your doctor or a dietician about the best diet for you during your pregnancy. It is also important for you to avoid alcohols, cigarettes and drugs that are likely to have a very negative impact on your pregnancy.

Protect your health

It is important to safeguard your health from disorders, such as infections, while you are pregnant. If you are a diabetic, keep it in proper management before and after your pregnancy.

Patent ductus arteriosus Complications

A small hear defect of this type does not give rise to any major problems. Larger PDA defects, that are left untreated, can give rise to complications like:

• Endocarditis, or infection of the heart
• Arrhythmia
• Heart failure
• Pulmonary Hypertension

In women with PDA, pregnancy can be an issue. While most women with small heart defects tolerate pregnancy, those having larger defects can have acute health complications if they become pregnant. Women with Eisenmenger’s Syndrome should avoid pregnancy as it can cause life risks for them.

Patent ductus arteriosus Pictures

Take a look at these images of Patent ductus arteriosus to know how this heart defect appears to view. Get a visual idea about the appearance of the defect.

Picture 1 – Patent ductus arteriosus

Picture 2 – Patent ductus arteriosus Image

While a small Patent ductus arteriosus may not need any treatment, larger ones require early medical attention. If anyone in your family has been diagnosed with PDA, do not neglect the condition. Seek medical cure as early as you can to ensure faster recovery and better management of the problem.

References:

http://www.mayoclinic.com/health/patent-ductus-arteriosus/DS00631

http://www.patient.co.uk/doctor/Patent-Ductus-Arteriosus.htm

http://www.nlm.nih.gov/medlineplus/ency/article/001560.htm

http://emedicine.medscape.com/article/891096-overview