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What is a PDA?

Patent ductus arteriosus also known as patent arterial duct is a small blood vessel (tube carrying blood) that connects the main body artery , the aorta, to the main lung artery, the pulmonary artery. This structure is present in the fetus, where it forms an important part of the circulation inside the womb. It is programmed by nature to shut down once babies are born and when babies  start using their lungs. Hence, it is more likely that these vessels may remain open when babies are born prematurely.



What are the signs?

Heart murmur is the most common sign of a PDA. It causes one of the most classic form of heart murmurs called machinery murmur and a diagnosis can often be made on clinical examination. When the PDA is moderate to large, the excessive flow through it causes the lungs to be flooded and lead to symptoms such as rapid breathing, poor feeding and sweating whilst feeding, poor weight gain and recurrent lower chest infections.



How is it diagnosed?

Dr Khambadkone will help make the diagnosis from the history and clinical examination, and confirmed by echocardiography, which helps in assessing the size of the PDA and its impact on the
circulation. Echocardiography helps in determining if the PDA can be closed by a keyhole procedure by
cardiac catheterization or by surgery. 



How is it treated?

Use of medications is necessary to reduce the fluid on the lung  to improve symptoms. Definitive treatment of PDAs can be performed by device closure with cardiac catheterisation performed by Dr Khambadkone or heart surgery by the cardiac surgeons. Catheterization is performed under general anaesthesia and involves inserting small tubes into the heart and blocking the flow using a plug made of a wire mesh from a special alloy. The procedure is often performed as a day case and children can go home on the same day. They usually return to normal activities within a couple of days. 


Do all PDAs needs treatment?

No. As with all congenital heart diseases, the treatment is individualized to the patient. Small PDAs that do not overburden the circulation do not need any treatment. These are often detected incidentally and are not even heard on examination and called “silent PDA”. Some small PDAs can cause enlargement of the left sided chambers of the heart and could be at a risk of infection and need treatment. Almost all moderate and large PDAs need treatment.

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