Management of patent ductus arteriosus
- Thomas Doyle, MD
Thomas Doyle, MD
- Associate Professor of Pediatrics
- Vanderbilt University School of Medicine
- Ann Kavanaugh-McHugh, MD
Ann Kavanaugh-McHugh, MD
- Associate Professor of Pediatrics
- Vanderbilt University School of Medicine
- Jonathan Soslow, MD
Jonathan Soslow, MD
- Assistant Professor of Pediatric Cardiology
- Vanderbilt University School of Medicine
- Kevin Hill, MD
Kevin Hill, MD
- Associate Professor of Pediatric Cardiology
- Duke University School of Medicine
- Section Editors
- John K Triedman, MD
John K Triedman, MD
- Section Editor — Pediatric Cardiology
- Professor of Pediatrics
- Harvard Medical School
- Heidi M Connolly, MD, FASE
Heidi M Connolly, MD, FASE
- Section Editor — Congenital Heart Disease
- Professor of Medicine
- Mayo Medical School
The ductus arteriosus (DA) is a fetal vascular connection between the main pulmonary artery and the aorta (figure 1) that diverts blood away from the pulmonary bed. After delivery, the DA undergoes active constriction and eventual obliteration. A patent ductus arteriosus (PDA) occurs when the DA fails to close postnatally. (See "Physiologic transition from intrauterine to extrauterine life".)
The management of PDA in full-term infants, older children, and adults will be reviewed here. PDA in the premature infant, and the pathogenesis, clinical manifestations, and diagnosis of PDA are discussed separately. (See "Pathophysiology, clinical manifestations, and diagnosis of patent ductus arteriosus in premature infants" and "Clinical manifestations and diagnosis of patent ductus arteriosus in term infants, children, and adults" and "Management of patent ductus arteriosus in preterm infants".)
INDICATIONS FOR CLOSURE
In patients with a patent ductus arteriosus (PDA), the primary management decision is whether to actively close the PDA, or to conservatively observe and monitor the patient's cardiac status on a regular basis . (See 'Management approach' below.)
PDA closure is recommended for patients with moderate or large PDAs associated with symptoms of significant left-to-right shunting, clinical evidence of left-sided volume overload (ie, left atrial or ventricular enlargement), or reversible pulmonary arterial hypertension (PAH) . Closure results in resolution of symptoms and a decrease in the likelihood or severity of PAH, and the development of irreversible pulmonary vascular disease (Eisenmenger syndrome). (See "Clinical manifestations and diagnosis of patent ductus arteriosus in term infants, children, and adults", section on 'Moderate PDA' and "Clinical manifestations and diagnosis of patent ductus arteriosus in term infants, children, and adults", section on 'Large PDA'.)
PDA closure is also indicated in patients with a previous episode of endocarditis regardless of the size of PDA in the absence of severe PAH.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- INDICATIONS FOR CLOSURE
- MANAGEMENT APPROACH
- Observation versus PDA closure
- Premature infants
- Term infants <5 kg
- Infants and children >5 kg
- - Occluder choice
- - Surgical ligation
- Adolescents and adults
- - Patients with PAH
- THERAPEUTIC INTERVENTIONS
- Pharmacologic therapy
- - Complications
- Percutaneous closure
- - Coil occlusion
- - Device occlusion
- - MRI compatibility
- Comparison between approaches
- LONG-TERM MANAGEMENT
- Antibiotic prophylaxis
- Sports participation
- SUMMARY AND RECOMMENDATIONS
- Indications for PDA closure