Patent-Ductus-Arteriosis

1. Patent Ductus
Arteriosis (PDA)

2. • Patent ductus arteriosus (PDA) is a persistent opening between the
two major blood vessels leading from the heart. Where this
connection doesn't close after birth as it's supposed to. This means
that extra blood is pumped into the lungs, forcing the heart and
lungs to work harder.
• A small patent ductus arteriosus often doesn't cause problems and
might never need treatment. However, a large patent ductus
arteriosus left untreated can allow poorly oxygenated blood to flow
in the wrong direction, weakening the heart muscle and causing
heart failure and other complications.
• Treatment options for a patent ductus arteriosus include
monitoring, medications, and closure by cardiac catheterization or
surgery.

3. PATHOPHYSIOLOGY
Schematic diagram of a left-to-right shunt of blood flow from the descending aorta
via the patent ductus arteriosus (PDA) to the main pulmonary artery.

4. • Closing the PDA can now usually be performed by catheter coil placement
or other device insertion to plug the abnormal communication.
• Surgery may be the best treatment option for some patients.
• An incision is made in the left side of the chest, between the ribs. The PDA
is closed by tying it with suture (thread-like material) or by permanently
placing a small metal clip around the PDA to squeeze it closed. Occasionally
in the adult, a surgical patch is used. If there's no other heart defect, this
restores the circulation to normal.

5. Symptoms
• Patent ductus arteriosus symptoms vary with the size of the defect
and whether the baby is full term or premature. A small PDA might
cause no signs or symptoms and go undetected for some time —
even until adulthood. A large PDA can cause signs of heart failure
soon after birth.
• Your baby's doctor might first suspect a heart defect during a regular
checkup after hearing a heart murmur while listening to your baby's
heart through a stethoscope.
• A large PDA found during infancy or childhood might cause:
• Poor eating, which leads to poor growth
• Sweating with crying or eating
• Persistent fast breathing or breathlessness
• Easy tiring
• Rapid heart rate

6. Causes
• Congenital heart defects arise from problems early in the heart's
development — but there's often no clear cause. Genetic factors
might play a role.
• Before birth, a vascular connection (ductus arteriosus) between two
major blood vessels leading from the heart — the aorta and
pulmonary artery — is necessary for a baby's blood circulation. The
ductus arteriosus diverts blood from a baby's lungs while they
develop, and the baby receives oxygen from the mother's circulation.
• After birth, the ductus arteriosus normally closes within two or three
days. In premature infants, the connection often takes longer to close.
If the connection remains open, it's referred to as a patent ductus
arteriosus.
• The abnormal opening causes too much blood to circulate to the
baby's lungs and heart. Untreated, the blood pressure in the baby's
lungs might increase (pulmonary hypertension) and the baby's heart
might enlarge and weaken.

7. Risk factors
• Risk factors for having a patent ductus arteriosus include:
• Premature birth. Patent ductus arteriosus (PDA) occurs more commonly
in babies who are born too early than in babies who are born full term.
• Family history and other genetic conditions. A family history of heart
defects and other genetic conditions, such as Down syndrome, increase
the risk of having a PDA.
• Rubella infection during pregnancy. If you contract German measles
(rubella) during pregnancy, your baby's risk of heart defects increases.
The rubella virus crosses the placenta and spreads through the baby's
circulatory system, damaging blood vessels and organs, including the
heart.
• Being born at a high altitude. Babies born above 10,000 feet (3,048
meters) have a greater risk of a PDA than babies born at lower altitudes.
• Being female. PDA is twice as common in girls.

8. Prevention
There's no sure way to prevent having a baby with a patent ductus
arteriosus. However, it's important to do everything possible to have a
healthy pregnancy. Here are some of the basics:
• Seek early prenatal care, even before you're pregnant. Quitting
smoking, reducing stress, stopping birth control — these are all things to
talk to your doctor about before you get pregnant. Also discuss
medications you're taking.
• Eat a healthy diet. Include a vitamin supplement that contains folic acid.
• Exercise regularly. Work with your doctor to develop an exercise plan
that's right for you.
• Avoid risks. These include harmful substances such as alcohol, cigarettes
and illegal drugs. Also avoid hot tubs and saunas.
• Avoid infections. Update your vaccinations before becoming pregnant.
Certain types of infections can be harmful to a developing baby.
• Keep diabetes under control. If you have diabetes, work with your
doctor to manage the condition before and during pregnancy.

9. NURSING MANAGEMENT AND CONSIDERATIONS
• Medical Follow-up
Patients with a small PDA need periodic follow-up with a
cardiologist.
• Activity Restrictions
Most patients with a small unrepaired PDA or a repaired PDA
don't need any special precautions and can participate in
normal activities without increased risk. Limitations on physical
activity for a short time even if there's no pulmonary
hypertension.
• Exercise restriction is recommended for patients with
pulmonary hypertension related to PDA.

10. THE END
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