How to treat patent ductus arteriosus?

Written by Tang Li
Cardiology
Updated on September 01, 2024
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The arterial duct connects the main pulmonary artery to the descending aorta, serving as the primary channel for blood circulation during the fetal period. After birth, it generally becomes obstructed within a few months due to disuse; if it remains open after one year, it is referred to as patent ductus arteriosus (PDA). The length and diameter of an unclosed arterial duct vary, affecting hemodynamics differently, and consequently, prognoses differ. An unclosed arterial duct can easily induce infectious endocarditis; thus, even if the shunt is small, it is advisable to seek early interventional or surgical treatment. The surgery has a high safety success rate and can be performed at any age. However, surgery is contraindicated for patients who have developed secondary pulmonary artery obstruction and exhibit right-to-left shunting.

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Written by Xie Zhi Hong
Cardiology
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Can patent ductus arteriosus be treated with medication?

The ductus arteriosus is a blood vessel connecting the pulmonary artery to the aorta in the fetal heart, primarily used during the embryonic stage to supply blood from the mother to the heart, thus providing sufficient oxygenated blood for fetal development and growth. Generally, the ductus arteriosus should close automatically within three months after birth. If it remains open for over a year, it may indicate a congenital heart defect known as patent ductus arteriosus. Previously, high doses of aspirin were used to treat this condition, but this treatment was not very effective. Patients with patent ductus arteriosus should instead consider minimally invasive interventional treatments to seal the duct, or surgical ligation can be performed. However, surgical ligation may cause significant trauma or scarring to the patient. The majority of cases with patent ductus arteriosus can be treated using minimally invasive methods.

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Written by Xie Zhi Hong
Cardiology
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Why does patent ductus arteriosus cause differential cyanosis?

The arterial duct refers to a blood vessel connecting the main pulmonary artery and the aorta, which is normally present during fetal development. It allows blood from the mother's placenta to seep into the pulmonary artery and then enter the aorta to supply the entire body's vasculature. After the birth of an infant, this blood vessel naturally closes, typically within 3 months, and most people will have it closed by 1 year. If it has not closed after 1 year, it is referred to as patent ductus arteriosus. Because the arterial duct can connect the aorta and the main pulmonary artery, blood from the systemic circulation in the aorta may directly return to the pulmonary artery at this time. If the pulmonary artery blood flow significantly increases, it can lead to pulmonary arterial hypertension and might also cause right ventricular hypertrophy. Increased cardiac workload can lead to right-sided heart failure and may also cause left-sided heart failure. When severe left-sided heart failure occurs, a right-to-left shunt can develop, which allows pulmonary artery blood to directly enter the aorta, causing venous blood to be delivered directly into the systemic circulation. At this point, differential cyanosis occurs, characterized by bluish discoloration of the upper limbs and mild blueness in the lower limbs.

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Written by Tang Li
Cardiology
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What are the symptoms of patent ductus arteriosus?

Patients with patent ductus arteriosus may exhibit several clinical manifestations based on the amount of shunting. 1. Small shunt volume: The internal diameter of the patent ductus arteriosus is small, and the patient may exhibit no subjective symptoms. The prominent sign is a continuous machinery murmur heard at the left sternal border at the second intercostal space and below the left clavicle, accompanied by a thrill; pulse pressure may slightly increase. 2. Moderate shunt: Patients commonly experience fatigue, palpitations, shortness of breath, and chest discomfort after exertion. The heart murmur is similar in character to the above but louder, accompanied by a thrill, and widely transmitted. At times, diastolic and mild systolic murmurs caused by left ventricular enlargement, relative mitral valve insufficiency, and stenosis can be heard at the apex, with a positive vascular sign. 3. Large shunt volume: This condition in a patent ductus arteriosus often accompanies secondary severe pulmonary hypertension, leading to a right-to-left shunt. The typical murmur's diastolic component may diminish or disappear, followed by the disappearance of the systolic murmur, and only a diastolic murmur due to pulmonic valve insufficiency can be heard. Patients often exhibit cyanosis and severe clinical symptoms.

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Written by Xie Zhi Hong
Cardiology
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What will happen if patent ductus arteriosus is not treated with surgery?

Patients with patent ductus arteriosus are characterized by a congenital connection between the pulmonary artery and the aortic arch. This is a remnant passageway that was used during embryonic development to supply blood within the umbilical vessels, ensuring the development of the infant. Normally, this ductus arteriosus may close on its own within a few months. If it does not close after one year from birth, it is considered a patent ductus arteriosus. This condition can lead to increased workload on the heart. Because it allows blood pumped into the aorta to return to the right ventricle, over time, this can increase the burden on the left ventricle as well as the right ventricle. This may lead to heart failure and, in severe cases, trigger Eisenmenger's syndrome. If this condition reaches such a state, the patient loses the opportunity for surgery, resulting in a shortened lifespan.

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Written by Xie Zhi Hong
Cardiology
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Can you drink alcohol with a patent ductus arteriosus?

Under normal circumstances, the ductus arteriosus in newborns gradually closes, and in most infants, the ductus arteriosus is completely closed within three months. However, for some people, even after one year of birth, the ductus arteriosus may not necessarily be diagnosed as congenital patent ductus arteriosus (PDA), a heart condition. Patients with this condition often experience pathological cardiac phenomena such as left-to-right shunts or right-to-left shunts. Due to these potential issues, the cardiac workload can worsen, leading to cardiac dysfunction and eventually heart failure. Drinking alcohol can potentially increase the patient's blood pressure and heart rate, adding more strain to the heart and exacerbating the condition. Therefore, it is advised that such patients avoid alcohol until after surgical treatment has been completed and their condition has stabilized. There are two methods of surgical treatment: most cases can be completely cured with interventional therapy, while a minority may require surgical ligation.