Abstract
The patent ductus arteriosus (PDA) is the most commonly found cardiac condition in neonates. While there have been several studies and thousands of publications on the topic, the decision to treat the PDA is still strongly debated among cardiologists, surgeons, and neonatologists. This is in part due to the shortage of long-term benefits with the interventions studied. Practice variations still exist within sub-specialties and centers. This article briefly summarizes the history, embryology and histology of the PDA. It also succinctly discusses the hemodynamic significance of a PDA which builds the framework to review all the available literature on PDA closure in premature infants, though not a paradigm shift just yet; it introduces transcatheter PDA closure (TCPC) as a possible armament to the clinician for this age-old problem.
Highlights
The patent ductus arteriosus (PDA) is the most common cardiac condition affecting neonates [1]
Mitra published a meta-analysis in 2018 which observed a higher probability of PDA closure and no increase in adverse outcomes when the dose was doubled [86]. Another RCT using early oral ibuprofen prophylaxis showed reduced rates of hemodynamically significant PDA (hsPDA) albeit not statistically significant and with a high prevalence of adverse events [87]. This is further support by a study that found lower serum ibuprofen levels in premature infants whose hsPDA did not close after 3-dose treatment; the trough after the first dose was significantly lower compared to the group of infants whose hsPDA did close after 3-dose treatment [88]
We have found that early PDA closure may afford better overall clinical outcomes in extremely low birth weight (ELBW) infants
Summary
The patent ductus arteriosus (PDA) is the most common cardiac condition affecting neonates [1]. Determining the volume of the shunt is a crucial step in deciding the course of action for premature infants with a PDA. Physicians use their clinical assessment, echocardiography, and indicators of systemic hypoperfusion or pulmonary over-circulation in order to quantify the shunt but this process has not been standardized [8, 9] and varies across institutions. Due to ventilation, the pulmonary vascular resistance is decreased and pulmonary blood flow is increased. This causes blood to shunt left to right through the DA. Predominant left to right shunting occurs within 10 min and is entirely left to right within 24 h of life [27]
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