Patent Ductus Arteriosus (PDA)

What is PDA?

PDA is a normal communication between descending aorta and left pulmonary artery. This is normally seen in fetal stage as well.

Normally it closes within 48 hours of life in majority of kids especially in term babies. In preterm babies, depending on his gestational age and weight of baby, sometimes it may take longer time to close spontaneously.

Clinical presentation of PDA in term infants?

It depends on size of PDA and symptoms of child.

If size of PDA is small, child is generally asymptomatic, and only continuous murmur will be there on examination.

If size of PDA is moderate (neither small nor big), child generally have history of poor weight gain, cough and cold etc.

In large sized PDA, child generally presents at 1-2 months of age with complaints of cough, cold, difficulty in breathing, poor weight gain, sweating over forehead.

Timing of closure of ASDs?

If size of PDA is small with no dilatation of left heart chambers then we do follow-up of child at periodic interval. Generally small PDA is closed between 12-18 months of age.

If moderate sized PDA,then it generally associated with left heart dilatation, then we should close the hole between 6 months-1 year of age.

In large sized PDA: we close between 3-6 months of age.

Can we close PDA by medications?

Yes, but only in premature babies.

What are the other options for closure of Preterm PDA?

If premature PDAs are not getting closed either by conservative management or by medications then either ligation of PDA by surgery or now we can close preterm PDA by device method (without surgery).

Which method is suitable for closing PDA?

It depends on size of PDA as well as on weight of the child.

Small sized PDA:closed now a day by using a device in cath lab by angiography.

Moderate sized PDA:Closing by method is decided by size of ASD and weight of child. Majority can be closed by device method in cath lab by angiography.

Large PDA: by surgical ligation.

Advantages of PDA closure by using Device (Non-surgical method)?
  1. Short hospital stay (2-3 days)
  2. No surgical scar on the body
  3. No need of any medication after procedure
  4. Can attend school from next day of discharge
  5. Can participate in all outdoor activities from very next day
  6. Very less risk as compared to surgery, although very safe procedure
  7. No requirement  of ventilator in most cases
Surgical options?

From back of the child by incision method.