Patent Ductus Arteriosus

In a preterm infant, obtain echocardiography when clinical findings raise concern for a left-to-right ductal shunt with pulmonary overcirculation or systemic hypoperfusion, or when escalating respiratory support prompts a physiology-based assessment. Echocardiography confirms PDA and defines ductal size, shunt direction, and the cardiovascular consequences that determine whether observation or closure-directed therapy is appropriate. BMJ+2BMJEarly protocol-based echocardiographic assessment and management of patent ductus arteriosus in infants less than 29 weeks’ gestation | BMJ Paediatrics OpenWileyEchocardiography for Patent Ductus Arteriosus Including Closure in ...WileyEffect of patent ductus arteriosus on pulmonary vascular disease

Do not equate a large ductal diameter with a hemodynamically significant PDA. Size-based thresholds correlate with echo-derived shunt-volume markers but are surrogate measures; the actionable assessment incorporates shunt direction and pattern, indices of pulmonary overcirculation, and markers of systemic hypoperfusion. BMJ+1BMJEarly protocol-based echocardiographic assessment and management of patent ductus arteriosus in infants less than 29 weeks’ gestation | BMJ Paediatrics OpenWileyRelationship of Patent Ductus Arteriosus Echocardiographic ...

In term infants, children, and adults, a persistent PDA is a congenital left-to-right shunt lesion rather than a transitional finding. Evaluate for left-heart volume overload, arrhythmia, and pulmonary hypertension; advanced pulmonary vascular disease may progress to Eisenmenger syndrome and materially changes closure candidacy. Wolters Kluwer+1Wolters KluwerManagement of Patent Ductus Arteriosus in the... : Cardiology in ReviewWileyEffect of patent ductus arteriosus on pulmonary vascular disease

For preterm PDA assessment, document ductal size, shunt direction, and shunt pattern; then measure or qualitatively assess left-heart volume loading, pulmonary overcirculation, and systemic hypoperfusion. The IWOA score is one physiology-oriented approach that incorporates these features; higher scores indicate greater hemodynamic significance. BMJBMJEarly protocol-based echocardiographic assessment and management of patent ductus arteriosus in infants less than 29 weeks’ gestation | BMJ Paediatrics Open

Interpret echocardiographic findings in the context of respiratory and perfusion trajectory. A persistent left-to-right shunt has been associated with bronchopulmonary dysplasia risk, but association does not establish that every detectable shunt requires closure. The Lancet+1The LancetCardiac catheterisation for closure of patent ductus arteriosusjtcvsManagement of premature infants with patent ductus arteriosus ...

Ensure image acquisition and Doppler alignment are adequate before making an intervention decision. In a targeted neonatal echocardiography pathway, archived studies underwent offline review to confirm completeness of views, measurement accuracy, and appropriate Doppler alignment; this is particularly relevant when serial studies are used to justify escalation. BMJBMJEarly protocol-based echocardiographic assessment and management of patent ductus arteriosus in infants less than 29 weeks’ gestation | BMJ Paediatrics Open

Before catheter or surgical intervention, use echocardiography to define ductal anatomy and procedural suitability. Echocardiography confirms the diagnosis and guides catheter-based and surgical intervention planning. WileyWileyEchocardiography for Patent Ductus Arteriosus Including Closure in ...

Most premature infants with PDA will experience spontaneous closure regardless of pulmonary disease. This natural history supports expectant management for infants without a clearly consequential shunt and avoids exposing all infants with PDA to medical or procedural adverse effects. jtcvsjtcvsManagement of premature infants with patent ductus arteriosus ...

When an infant has persistent hemodynamic significance with cardiopulmonary compromise, choose among pharmacologic therapy, transcatheter closure, and surgical ligation after considering renal function, bleeding risk, sepsis, coagulopathy, anatomy, and access to experienced procedural teams. Conservative management, pharmacologic intervention, surgery, and transcatheter closure are all used for hemodynamically significant PDA. Nature+2NaturePatent ductus arteriosus treatment trends and associated morbidities in neonates | Scientific ReportsScienceDirectDuctus Arteriosus Obliteration - an overview | ScienceDirect TopicsPubMedAnesthesia for Patients With Patent Ductus Arteriosus - StatPearls - NCBI Bookshelf

A targeted neonatal echocardiography screening pathway in infants born before 29 weeks' gestation was associated, in a pre-post observational study, with fewer invasive-ventilation days, lower BPD rates, and no surgical ligations in the post-screening period despite similar medical-treatment rates. Use this evidence to support physiology-guided selection, not to infer that screening itself causally improves outcomes. BMJBMJEarly protocol-based echocardiographic assessment and management of patent ductus arteriosus in infants less than 29 weeks’ gestation | BMJ Paediatrics Open

Transcatheter closure is the preferred approach for most persistent PDA cases when anatomy and patient characteristics allow device deployment. In adults, surgical repair is generally reserved for distinct ductal anatomy or concurrent intracardiac pathology requiring surgery. Wolters KluwerWolters KluwerManagement of Patent Ductus Arteriosus in the... : Cardiology in Review

In infants, transcatheter closure has become more common relative to surgical ligation. A pediatric administrative-database comparison cited lower mortality and shorter length of stay with transcatheter closure than surgical ligation, but procedure selection remains vulnerable to anatomic and illness-severity confounding. PubMedPubMedAnesthesia for Patients With Patent Ductus Arteriosus - StatPearls - NCBI Bookshelf

For very preterm infants, anticipate acute hemodynamic change after either modality. Post-ligation cardiac syndrome and post-transcatheter cardiorespiratory syndrome may occur; assess cardiovascular and respiratory status promptly after closure rather than attributing deterioration solely to lung disease. Nature+1NatureComparison of neurodevelopmental outcomes of extremely preterm infants undergoing trans-catheter closure of the patent ductus arteriosus compared to surgical ligation | Journal of PerinatologyScienceDirectCatheter-based closure of the patent ductus arteriosus in lower weight infants - ScienceDirect

For term infants and children with a small-to-moderate PDA, transcatheter device closure is the usual definitive pathway. For large ducts or symptomatic infants too small for device closure, surgical closure may be required. BMJBMJPatent ductus arteriosus - Symptoms, diagnosis and treatment | BMJ Best Practice US

In adults, quantify the clinical impact of the persistent shunt before intervention, specifically left-heart volume overload, arrhythmias, and pulmonary hypertension. Untreated PDA can progress to Eisenmenger syndrome; pulmonary vascular disease therefore requires deliberate hemodynamic and congenital-cardiology evaluation before closure. Wolters Kluwer+1Wolters KluwerManagement of Patent Ductus Arteriosus in the... : Cardiology in ReviewWileyEffect of patent ductus arteriosus on pulmonary vascular disease

Indomethacin is rarely effective in full-term infants and older patients. Persistent congenital PDA should therefore be referred for device or surgical closure assessment rather than repeated prostaglandin-inhibitor courses. ScienceDirectScienceDirectDuctus Arteriosus Obliteration - an overview | ScienceDirect Topics