Patent Ductus Arteriosus

Patent ductus arteriosus is persistence after birth of the fetal communication between the descending aorta and pulmonary artery.

The haemodynamic effect depends on duct size and pulmonary vascular resistance.

• Continuous machinery type murmur
• Bounding pulses
• Wide pulse pressure
• Hyperdynamic precordium

Large PDA may cause:

• Tachypnoea
• Feeding difficulty
• Poor growth
• Heart failure

Echocardiography confirms ductal patency and haemodynamic significance.

Small asymptomatic PDA may be observed or electively closed according to cardiology assessment.

Significant PDA beyond the neonatal period is usually closed by transcatheter device where anatomically suitable.

In preterm infants with haemodynamically significant PDA, pharmacological closure may use ibuprofen or paracetamol according to neonatal protocol.

Established pulmonary vascular disease with right to left shunting requires specialist assessment because closure may be contraindicated.