Patent Ductus Arteriosus (PDA) Closure: Procedure Cause, and Symptoms

Patent ductus arteriosus (PDA) is a congenital heart condition where there's an ongoing opening between two major blood vessels. This happens when the usual closure of a vessel, called the “ductus arteriosus”, doesn't occur after birth. While a small PDA may not pose issues and might not need treatment, a larger, untreated one can lead to complications like weakened heart muscles and heart failure. Treatment options include regular checkups, medications, or a procedure to close the opening if necessary.

The exact reason why DA remains open (patent) in some infants is still unknown. However, girls are twice as likely to suffer from PDA as boys. Additionally, PDA may occur in combination with other heart defects as well.

PDA, if left untreated, may lead to several complications. Because of the flow of oxygenated blood from the aorta to the pulmonary artery and the mixing of blood, the vessels of the lungs have to handle a large amount of blood. The larger the volume of blood that enters the pulmonary artery, the greater they have to cope with the increased pressure. This may lead to long-term damage to the lungs.

Patent Ductus Arteriosus (PDA) can be classified into different types based on various factors such as size, clinical presentation, and associated conditions. The primary types include:

Small PDA: these are typically asymptomatic.may not require immediate treatment.
Moderate-sized PDA: May cause mild symptoms or complications.

Treatment decisions depend on individual cases

Large PDA: More likely to cause noticeable symptoms.Increased risk of complications like heart failure.
Complex PDA: PDA occurs alongside other heart abnormalities.
Symptomatic PDA: This PDA has noticeable symptoms such as poor feeding, breathing difficulties, or fatigue.
PDA in Preterm Infants: This is more common in premature babies, and may close on its own or require medical intervention.

The classification helps healthcare professionals tailor treatment plans based on the specific characteristics and needs of individuals with Patent Ductus Arteriosus.

Symptoms of Patent Ductus Arteriosus (PDA) vary with the size of the opening and the person's age. In some cases, a small PDA may not show any symptoms, and some people might not notice them until adulthood. However, a large PDA can lead to symptoms of heart failure shortly after birth.
For infants or children with a significant PDA, symptoms may include

Difficulties in eating,
Poor growth
Sweating during crying or eating
Persistent rapid breathing
Breathlessness
Quick fatigue.

Diagnosis of Patent Ductus Arteriosus (PDA) typically involves a combination of clinical evaluation and various diagnostic tests. Common diagnostic methods include:

Physical Examination: A Doctor may detect certain signs during a routine physical examination, such as abnormal heart sounds (murmurs) or other symptoms.
Echocardiogram: This non-invasive imaging test uses sound waves to create detailed images of the heart's structure. It can visualize the ductus arteriosus and assess its size and characteristics.
Chest X-ray: X-ray images of the chest can provide information about the size and condition of the heart and lungs, aiding in the diagnosis of PDA.
Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart, helping to identify any abnormal rhythms or patterns associated with PDA.
Cardiac MRI (Magnetic Resonance Imaging): MRI provides detailed images of the heart and blood vessels, offering additional information about the structure and function of the heart.
Cardiac Catheterization: An invasive procedure involves the insertion of a thin tube (catheter) into the blood vessels to directly visualize the ductus arteriosus and measure pressures.
Oxygen Saturation Monitoring: Continuous monitoring of oxygen saturation levels in the blood may be used to detect abnormal patterns associated with PDA.

PDA closure is performed under the influence of a general anesthetic (GA) using the heart catheterization procedure. During the closure, the surgeon places a closure device into the catheter. A typical PDA closure device is made up of mesh and metal material. It is a short tube with discs of different sizes on both ends. The device is folder before its insertion into the catheter.

The device is moved out of the catheter upon reaching the right place. One of the appropriate discs opens up when the device is moved out of the catheter. It acts like a plug and seals off the PDA, stopping the flow of oxygenated blood to the pulmonary artery.

The catheter is usually inserted into a blood vessel in the groin region. The catheter is gently moved up to reach the site of PDA. The closure device is threaded through to reach the PDA site and is placed in the targeted position. Once the device is in place, the catheter is withdrawn and the site of catheter insertion is bandaged.

The procedure takes one to three hours to complete. As soon as the procedure is over, the child is transferred to the recovery room and is kept there as long as the effect of the GA fades off. Most of the children are discharged on the same day as the PDA closure procedure. However, they will be required to stay in the hospital for at least four to six hours after the surgery.

Some children, however, will be required to stay in the hospital overnight. They are transferred to the inpatient unit after the effect of the GA is over. A chest X-ray is conducted the next day in the case of all patients to check the position of the closure device. Children who are discharged on the same day of the procedure must be brought to the hospital again the next morning for an X-ray.

The surgeon may prescribe a few antibiotics after the surgery to prevent heart infection known as infectious endocarditis. It is common for premature infants or infants with larger PDA to become tired of feeding. Therefore, care must be taken to high-calorie formula or breast milk them for normal growth and development.