pediatrics
Patent Ductus Arteriosus (PDA)
Key Points
Patent ductus arteriosus (PDA) is a persistence after birth of the normal fetal connection (ductus arteriosus) between the aorta and pulmonary artery, resulting in a left-to-right shunt. Manifestations depend on the size of the PDA and the age of the child, but a continuous murmur is characteristic and, if loud, has a “machinery sounding” quality. Preterm infants may have respiratory distress or other serious complications (eg, necrotizing enterocolitis). Over time, a large shunt causes left heart enlargement, pulmonary artery hypertension, and elevated pulmonary vascular resistance, ultimately leading to Eisenmenger syndrome if untreated. For preterm infants with hemodynamically significant PDA, give a cyclo-oxygenase (COX) inhibitor (eg,ibuprofen lysineorindomethacin). Surgical or transcatheter closure may benefit patients with a hemodynamically significant PDA in whom medical therapy has failed. For full-term infants and older children, COX inhibitors are usually ineffective, but a catheter-delivered occlusion device or surgery typically provides long-term correction of this anomaly. 