Patent Ductus Arteriosus

Treatment

A small patent ductus arteriosus may close spontaneously as a child grows. A larger PDA that causes symptoms requires medical management and possibly surgical repair. There are two reasons to close a PDA. One, a large PDA directs extra blood to the lungs, which may result in enlargement of the heart and, over time, heart failure. Second, treatment minimizes the risk of developing an infection in the heart known as endocarditis.

Mayo Clinic specialists have extensive experience in treating children and adults who have PDA. Patient's care is coordinated through a team of specialists from the Center for Congenital Heart Disease.

Children needing hospitalization are cared for at Mayo Eugenio Litta Children's Hospital in Rochester.

A specific treatment plan is determined by the treatment team based on:

• The baby's overall health and medical history
• The baby's tolerance for specific medications, procedures or therapies
• The parents' wishes

There are three treatment options:

Surgery

PDA ligation is used in full-term infants who show signs of heart failure or signs of excessive stress on the blood vessels in the lungs. The goal of PDA ligation is to repair the patent ductus arteriosus before the lungs become diseased from too much blood flow and pressure. A surgeon closes the ductus arteriosus by tying or clipping it, without opening the heart. An incision is made on the left side of the chest near the armpit, through which the PDA is exposed where it attaches to the aorta. The tie or clip is placed directly around the PDA and the flow across the PDA is stopped immediately. Clipping or tying can also be done through four small incisions on the left side of the chest, with special instruments designed for use through such tiny incisions. If the infant has no symptoms, the operation can be postponed until 6 months to 3 years of age. PDA ligation is performed under general anesthesia.

Transcatheter Procedure

The second treatment option uses a transcatheter (a long, thin tube) to place plugs or coils to stop blood flow through the patent ductus arteriosus. This method is often used to treat small PDAs. The transcatheter is inserted into the body, usually in the groin area, and is guided through an artery to the defect. A tiny device on the tip of the catheter (called an intravascular coil or occluder) is used to block the passageway.

Medication

Indomethacin is sometimes used in newborns and infants. This drug helps to constrict the muscle in the wall of the patent ductus arteriosus to close it. Other medications used to help the heart and lungs work better include digoxin, which strengthens heart muscle, and diuretics, a class of drugs that help the body remove excess fluids.