Anders, M. Patent ductus arteriosus, Don't Forget the Bubbles, 2013. Available at:
Definition: postnatal communication between MPA and descending aorta. Incidence 0.3-4:10.000
Functional closure of DA is usually within 10-15 hrs of birth (triggered by a rise in paO2 and decrease in PGE2 and PGI2). However VLBW and especially ELBW infants have a symptomic persistent PDA (reduced sensitivity to all the above). The PDA leads to increased PBF and increased LV volume load.
Echo (PDA >1.4mm/kg, LA or LV enlargement; diastolic flow reversal in the descending aorta indicates haemodynamic significance); BNP >1000pg/ml.
Problems in PDA:
- Neonates: prolonged ventilation → BPD/CLD, IVH, PVL, NEC.
- Children/Adolescents: LVH (→ CCF), Eisenmenger syndrome, growth restriction, aneurysmal dilation of PDA, calcification, infective endocarditis.
ECG, CXR, CUS, FBE, clotting, UEC, PRBC (2), FFP (2), platelets (1), cryoprecipitate (2).
Methylprednisolone 10mg/kg 12hrs and 6hrs pre surgery in neonates.
Transcatheter PDA closure or surgical ligation by left posterolateral thoracotomy or VAT.
Usually unproblematic postoperative course, nil support required, early extubation if feasible.
Low mortality and morbidity (potentially adverse events include: laryngeal nerve damage, chylothorax, pneumothorax, bleeding).
References: Critical Heart Disease in Infants and Children; 2nd ed, Nichols et al: Aortopulmonary Septal Defects and Patent Ductus Arteriosus  Ann Surg. 46:33; 1907: Munro: Surgery of the vascular system, I. Ligation of the ductus arteriosus  Ann Pediatric Card. 2009;2: 36-40:Azhar et al: Transcatheter closure of patent ductus arteriosus: evaluating the effect of the learning curve on outcome