Guide To Managing Patent Ductus Arteriosus

April 18, 2024

Patent ductus arteriosus is a congenital heart defect that occurs when the ductus arteriosus, a normal hole in the aorta present before birth, fails to close once the baby is born. Typically, the ductus arteriosus closes naturally within a few days of the baby's birth. Premature infants are more likely to have patent ductus arteriosus. While small openings may not need treatment, larger openings could enable blood to flow in the wrong direction, leading to a weak heart and heart failure. Patent ductus arteriosus is twice as common in female patients as it is in males, and babies born at altitudes above ten thousand feet are at an elevated risk of this heart condition. If a mother experiences rubella during her pregnancy, the baby may have an increased risk of patent ductus arteriosus and other congenital heart issues. Symptoms associated with significant patent ductus arteriosus include sweating while feeding, fatigue, rapid heartbeat, and an increased respiration rate. To diagnose this condition, doctors will listen to the patient's heart to check for a heart murmur. Electrocardiograms, echocardiograms, and chest x-rays are needed to confirm the diagnosis.

The methods outlined below are beneficial in the treatment and management of patent ductus arteriosus.

Surgical Intervention

Surgical intervention is generally recommended for babies who have not responded to medication and other conservative treatments. Typically, doctors suggest surgery only in cases where the patent ductus arteriosus is large and causing significant complications. The operation is normally carried out within the first year of the child's life. For babies with severe symptoms, surgeons advise the procedure be performed within the first six months of the child's life. To perform the surgery, doctors make an incision between the ribs to access the heart. Then, the opening is closed using stitches or a metal clip. After the procedure, patients remain in the hospital for a few days, and they need a few weeks of additional recovery time at home. This procedure restores blood circulation to normal, and most patients have an excellent prognosis with no need for additional surgery.

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Catheter Procedures

Catheter procedures are usually the first invasive treatment doctors attempt when treating patent ductus arteriosus. While the procedure is appropriate for the vast majority of patients with this condition, premature infants cannot have this particular procedure due to their small size. To be eligible for a catheter procedure, patients must weigh at least five kilograms. Catheter procedures can often be performed using minimally invasive methods, and patients may be able to have the procedure at an outpatient surgery facility. During the procedure, a catheter is placed in a blood vessel in the patient's groin, and surgeons advance it until it reaches the affected area of the heart. Once they are in the correct location, doctors release a plug or a coil that has been inserted into the catheter, and this closes the ductus arteriosus.

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Specific Medications

In premature infants, the use of specific medications may help with patent ductus arteriosus. Normally, doctors recommend ibuprofen and indomethacin for this purpose. Both of these block certain hormone-like substances in the body that prevent proper closure of the ductus arteriosus. While ibuprofen may be given orally, indomethacin is given intravenously. Indomethacin causes the muscles within the ductus arteriosus to constrict, which can promote effective closure. Ibuprofen, indomethacin, and similar medicines are only useful in closing the ductus arteriosus of premature babies; these medications are ineffective for full-term infants and adults with the condition. Some infants, including both premature and full-term babies, will need to take other medications that improve the functioning of the heart and lungs. Diuretics, which remove excess fluid from the body through urination, may be needed for these patients, too. Since patent ductus arteriosus can compromise heart function, this might upset the water balance within the body, and diuretics could help correct this.

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Preventative Antibiotics

Patients with patent ductus arteriosus are at an increased risk of a heart infection known as endocarditis. To reduce the risk of developing this infection, preventative antibiotics are sometimes indicated. Current guidelines recommend antibiotics be prescribed for the first six months after a patient has a catheter procedure. They are also advised for patients who have heart damage after a catheter procedure or other repair, and individuals who have had previous heart infections need them as well. In the past, doctors advised patients with patent ductus arteriosus to take preventative antibiotics before having dental work or invasive medical procedures. However, these guidelines were recently revised, and doctors now only recommend the antibiotics in the situations described above.

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Get Regular And Appropriate Exercise

To strengthen the heart, doctors routinely advise patients with this condition to get regular and appropriate exercise. Prior to beginning any exercise routine or playing sports, patients with patent ductus arteriosus should check with their cardiology team about the safest types of exercises for their individual needs. They should also ask questions about safe time limits for exercise. Some patients may need to restrict their activity for a period of time. For example, patients who have pulmonary hypertension as a result of patent ductus arteriosus will normally have exercise restrictions put in place by their cardiologist. Patients who have recently had a catheter procedure or surgical repair for this cardiac issue will also have a short period of activity restriction. The doctor will advise patients who have had recent repairs when it is safe to begin exercising. Patients who have small cases of patent ductus arteriosus that have not been repaired can normally exercise without any restrictions. Generally, parents should not worry about vigorous exercise or rough play for their child if they have not had any exercise restrictions issued by a healthcare provider.

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