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The ductus arteriosus is a normal vascular channel during intrauterine life. It is a large vessel with a muscular wall which courses between the pulmonary artery and the aorta.
The ductus arteriosus normally closes within the first 48 hours of life. If it remains patent longer than this it is unlikely to close spontaneously. The exception is in premature babies where closure should occur within 3 months.
A persistently patent ductus is a common congenital heart lesion, occurring either singly or in combination with other defects.
It is more common in:
- girls than in boys
- congenital rubella syndrome
- premature babies
For a hemodynamically significant PDA that does not
spontaneously close, a medical or surgical intervention may be
chosen to achieve ductal closure.
- procedural interventions include
surgical ligation and transcatheter occlusion
agents include cyclooxygenase inhibitors, such as ibuprofen or
indomethacin, and acetaminophen (paracetamol), which is a
derivative of acetanilide with weak anti-inflammatory properties.
- fetal circulation relies on the placenta, as well as on a patent
ductus arteriosus (PDA)
- ductus arteriosus
connects the main pulmonary artery to the proximal descending
aorta, allowing the vast majority of right ventricular output to
bypass the pulmonary circulation
- shortly after
birth, with initiation of breathing and separation of the low resistance
placenta, functional closure of the ductus arteriosus commences
- physiological mechanisms for closure include:
oxygen tension and decreased circulating prostaglandin (PGEQ) and
- generally occurs within 24 to 72 hours
of birth in the term infant (3)
- note that the ductus
arteriosus frequently fails to close in the preterm infant, with an
inverse relationship between gestational age and ductal patency (3)
- failure of the ductus arteriosus to close in preterm infants is
partially related to altered physiological mechanisms, including
increased ductal sensitivity to the vasodilatory effects of
prostaglandins and nitric oxide
- 70% of infants
born before 28 weeks' gestational age have historically received
medical or surgical closure of the PDA (3)
- infants with
respiratory distress syndrome (RDS), as well as
those with perinatal asphyxia, are more likely to have
a significant PDA present, as are infants who receive large volumes
of fluid early in their life (4)
- likelihood of spontaneous
closure of a PDA in infants less than or equal to 1500 grams remains
high, reaching 85% in one cohort before discharge (5)
- D. Hull & D.I. Johnston in Essential Paediatrics, 3rd edition, Churchill Livingstone, Edinburgh, p.138-9
- R.S. Cotran, V. Kumar and S.L. Robbins in Robbins Pathologic Basis of Disease, 4th edition, W.B. Saunders Co., Philadelphia, p.623-4
- Clyman RI. Ibuprofen and patent ductus arteriosus. New
England Journal of Medicine 2000;343(10):728-30.
- Bell EF et al. Effect of fluid
administration on the development of symptomatic patent
ductus arteriosus and congestive heart failure in premature
infants. New England Journal of Medicine 1980;302(11):598-604
- Semberoval J et al. Spontaneous closure of patent ductus arteriosus in infants </=1500 g. Pediatrics 2017;140(2):e20164258
Last edited 03/2021 and last reviewed 04/2021