Treatments for patent ductus arteriosus in children | Boston Children's Hospital

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What are the treatments for patent ductus arteriosus? 

A small patent ductus arteriosus may close spontaneously as your child grows.

A PDA that causes symptoms will require medical management, and possibly even surgical repair. Your child's cardiologist will check periodically to see whether the PDA is closing on its own.

If a PDA does not close on its own, it will be repaired to prevent lung problems that will develop from long-term exposure to extra blood flow.

Treatment may include: 

Medical management

In premature infants, an intravenous (IV) medication called indomethacin may help close a patent ductus arteriosus. Indomethacin is related to aspirin and ibuprofen and works by stimulating the muscles inside the PDA to constrict, thereby closing the connection.

Your child's physician can answer any questions you may have about this treatment. Some children will have no symptoms and do not require medications. Others may need to take medications to help the heart and lungs work better. Medications that may be prescribed include:

  • digoxin - a medicine that helps strengthen the heart muscle, enabling it to pump more efficiently
  • diuretics – medications that help the kidneys remove excess fluid from the body

Adequate nutrition

Most infants with PDA eat and grow normally, but premature infants or those infants with a large PDA may become tired when feeding, and are not able to eat enough to gain weight. Options that can be used to ensure your baby will have adequate nutrition include:

  • high-calorie formula or breast milk
  • supplemental tube feedings - feedings given through a small, flexible tube that passes through the nose, down the esophagus and into the stomach

Surgery

The goal is to repair the patent ductus arteriosus before the lungs become diseased from too much blood flow and pressure. Surgical repair is usually recommended for infants younger than 6 months of age who have large defects that are causing symptoms, such as poor weight gain and rapid breathing. For infants who aren't showing any symptoms, the repair may often be delayed until after 6 months of age.

Your child's cardiologist will recommend when the repair should be performed. Your child's PDA may be repaired surgically in the operating room or by a cardiac catheterization procedure. The surgical repair, also called PDA ligation, is performed under general anesthesia. The procedure involves closing the open PDA with stitches to prevent the surplus blood from entering your child's lungs. In selected cases, robotic surgery equipment is used to correct PDA using minimally-invasive surgery techniques.

Cardiac catheterization

During this procedure, the child is sedated and a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin and guided to the inside of the heart. Once the catheter is in the heart, the cardiologist pass a special device, called a coil or occluder, into the open PDA, preventing blood from flowing through it.  Advancements in cardiovascular surgical repair include video-assisted thoracoscopic surgery. Children need to be at least 5 kg to be considered for transcatheter closure. Thus, premature infants, because of their small size, are not candidates for this procedure, and require surgical closure of the PDA.

What is the long-term outlook for my child after PDA surgery?

In premature infants, the outlook after PDA surgery depends on the following: 

  • your child's gestational age
  • any other illnesses present in your baby

Most children born full-term with a patent ductus arteriosus repair will live healthy lives after recovering from the hospitalization. Their activity levels, appetite and growth should return to normal.

In some cases, your child's cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis after you leave the hospital

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