Why does ductus arteriosus close

Over time this may cause permanent damage to the lung blood vessels pulmonary hypertension. If the PDA is small, it doesn't have to be closed because it doesn't make the heart and lungs work harder. Patients with a moderate- or large-sized PDA may develop problems related to the increased blood flow to the lungs.

These patients may have improvement if the PDA is closed. Closing the PDA can now usually be performed by catheter coil placement or other device insertion to plug the abnormal communication referred to as interventional or therapeutic catheterization PDF. Surgery may be the best treatment option for some patients.

The surgeon doesn't have to open the heart to fix the PDA. An incision is made in the left side of the chest, between the ribs. The PDA is closed by tying it with suture thread-like material or by permanently placing a small metal clip around the PDA to squeeze it closed. Occasionally in the adult, a surgical patch is used. If there's no other heart defect, this restores the circulation to normal.

If the PDA is small, or if the PDA has been closed with catheterization or surgery, you may not need any special restrictions and may be able to participate in normal activities without increased risk. Patients with moderate or large PDAs and patients with pulmonary hypertension may need to restrict activity. They should discuss this with their cardiologist. Depending on the type of PDA closure, your cardiologist may examine it periodically to look for uncommon problems. Patients with a small PDA need periodic follow-up with a cardiologist.

Patients with a PDA that's been successfully closed rarely require long-term cardiology follow-up unless there's additional cardiac disease. Only rarely will they need to take medicine after surgical or device closure. Your cardiologist can monitor you with noninvasive tests if needed. Most patients with a small unrepaired PDA or a repaired PDA don't need any special precautions and can participate in normal activities without increased risk.

After surgery or catheter closure, your cardiologist may advise some limitations on your physical activity for a short time even if there's no pulmonary hypertension. Endocarditis prophylaxis is generally not needed more than six months after PDA device closure.

However, endocarditis prophylaxis is recommended for PDA patients with a history of endocarditis, for those with prosthetic valve material and for unrepaired PDA with associated pulmonary hypertension and cyanosis. See the section on endocarditis for more information.

Unless there's pulmonary hypertension or signs of heart failure, pregnancy is low risk in patients with PDA. Symptoms of congestive heart failure include rapid breathing, feeding problems, slow weight gain, low energy, and cold, clammy sweating. If the PDA remains large, over time the extra blood flow damages the pulmonary artery and they become stiff and thickened.

This condition, called pulmonary vascular disease is a very serious problem for which there is currently no effective treatment. Children with patent ductus arteriosus are also at increased risk for subacute bacterial endocarditis SBE. This is an infection of the heart caused by bacteria in the blood stream. It can occur after a dental or other medical procedure but can usually be prevented by a dose of antibiotic prior to the procedure.

For this reason, many doctors recommend closure of even small PDAs. Exercise recommendations: Exercise recommendations are best made by a patient's doctor so that all relevant factors can be included in the decision. In general, exercise restrictions for patients with patent ductus arteriosus are not necessary and children can participate in competitive and vigorous athletic activities.

Clinical findings: Most children with PDA do not have heart related symptoms. If the ductus is large in size, symptoms of congestive heart failure may develop. Congestive heart failure can develop at any time but more commonly presents during the first 2 to 3 months of life. The symptoms include rapid breathing, poor feeding, slow growth, and cold, clammy sweating. Physical findings: A heart murmur is often the only clue that a child has a PDA.

If the child is in congestive heart failure, there will be poor weight gain, the heart rate and breathing rate will be higher than normal, and the liver will be enlarged. Medical tests: Medical tests that provide helpful information include an electrocardiogram, oxygen saturation test, and chest x-ray.

The diagnosis is confirmed by an echocardiogram. As described earlier, small PDAs do not cause symptoms so generally treatment other than SBE prophylaxis is not needed. Many children will have spontaneous closure of the ductus during the first year of life. It is given by IV intravenously. Indomethacin stimulates the muscles inside the PDA to tighten. This closes the connection. Your child's cardiologist can answer any questions you may have about this treatment.

Some babies may need medicine to help the heart and lungs work better. Sometimes a baby may need medicine such as diuretics water pills. Diuretics help the kidneys remove extra fluid from the body.

This may be needed when the heart is not working well. Or it may be needed if the blood vessels in the lungs have to make room for more blood flow, as with a PDA. Most infants with PDA eat and grow normally. Some premature infants or those infants with large PDAs may get tired when feeding. They may not be able to eat enough to gain weight. Nutrition choices include:. High-calorie supplements.

Special nutritional supplements may be added to formula or pumped breastmilk to increase the number of calories. Your baby can drink less and still have enough calories to grow correctly. Supplemental tube feedings. Supplemental feedings are given through a small, flexible tube. The tube passes through the nose, down the food pipe esophagus , and into the stomach. The feedings can either be added to or take the place of bottle-feedings.

Infants who can drink part of their bottles, but not all, may be fed the rest through the feeding tube. Babies who are too tired to bottle-feed may get all of their formula or breastmilk through the feeding tube.

For this test, your baby will be given medicine to relax sedation. The healthcare provider will put a thin, flexible tube catheter into a blood vessel in the groin. He or she will guide it through the large blood vessel in the groin to the area of the PDA.

The catheter will be placed in the PDA. Dye may be injected at this time to help the provider put the catheter in the right place. A coil or closure device which is attached to the catheter will then be placed in the PDA.

This will stop blood from flowing through the PDA. Congenital heart defects arise from problems early in the heart's development — but there's often no clear cause. Genetic factors might play a role.

Before birth, an opening that connects two major blood vessels leading from the heart — the aorta and pulmonary artery — is necessary for a baby's blood circulation. The connection diverts blood from a baby's lungs while they develop, and the baby receives oxygen from the mother's circulation.

After birth, the ductus arteriosus normally closes within two or three days. In premature infants, the opening often takes longer to close. If the connection remains open, it's referred to as a patent ductus arteriosus. The abnormal opening causes too much blood to flow to the baby's lungs and heart.

Untreated, the blood pressure in the baby's lungs might increase pulmonary hypertension and the baby's heart might enlarge and weaken. A small patent ductus arteriosus might not cause complications. Larger, untreated defects could cause:. Most women who have a small patent ductus arteriosus can tolerate pregnancy without problems. However, having a larger defect or complications — such as heart failure, arrhythmias or pulmonary hypertension — can increase the risk of complications during pregnancy.

If you have Eisenmenger syndrome, pregnancy should be avoided as it can be life-threatening. If you have a heart defect, repaired or not, discuss family planning with your doctor.

In some cases, preconception consultations with doctors who specialize in congenital cardiology, genetics and high-risk obstetric care are needed. Some heart medications can cause serious problems for a developing baby, and it might be necessary to stop or adjust the medications before you become pregnant.

There's no sure way to prevent having a baby with a patent ductus arteriosus. However, it's important to do everything possible to have a healthy pregnancy.