To Close or Not to Close: The Very Small Patent Ductus Arteriosus

Abstract

Patent ductus arteriosus (PDA) accounts for approximately 10% of all congenital heart diseases, with an incidence of at least 2–4 per 1000 term births. Closure of the large, hemodynamically significant PDA is established as the standard of care, and can be performed safely and effectively using either surgical or transcatheter methods. The appropriate management of the very small, hemodynamically insignificant PDA is less clear. Routine closure of such defects has been advocated to eliminate or reduce the risk of infective endocarditis (IE). However, the risk of IE in patients with a small PDA appears to be extremely low, and IE is treatable. Although closure of the small PDA is generally safe and technically successful, it is unknown whether this treatment truly improves the risk : benefit balance compared with observation. In this article, we review the published literature on the natural history and treatment outcomes in individuals with a PDA, the epidemiology and outcomes of IE, particularly in association with PDA, and the rationale and evidence for closure of the very small PDA.

Persistent Ductus Arteriosus in Critically Ill Preterm Infants

“…Ductus arteriosus persistence was also associated with an increased risk of NEC in very preterm infants, and other studies [11,21,43,44,47,70]. The current study also showed an increased incidence of NEC in preterm infants ≤ 32 weeks gestation, but the low number of NEC cases may explain the lack of significance of this association (Table 4).…”

“…[6,11,43,45,47,63]. In the short term, PDA is associated with arterial hypotension, myocardial dysfunction and systemic perfusion [5,8,38], renal functional disturbances [5,19,39], and pulmonary hemorrhage [40,64,65].…”

“…In "term infants, " PDA occurs in 0.3-4/1000 live births at the end of the neonatal period, representing 5-10% of the congenital heart defects [2,10,11]. Sometimes PDA accompanies congenital ductal-dependent heart defects and closure of the PDA soon after birth may precipitate clinical deterioration [12].…”

“…In the short term, PDA is associated with decreased blood pressure [5,8], decreased renal function [5], cardiac congestive failure [18,37,38], pulmonary haemorrhage [8,39], apnea and ventilator-dependency [6,38], bronchopulmonary dysplasia (BPD) [5,14,20,21,25,34,41,42], necrotizing enterocolitis (NEC) [8,9,11,19,20,34,39,43,44], intraventricular hemorrhage (IVH) [5,19,20,39,42,45,46], periventricular leukomalacia (PVL) [5], retinopathy of prematurity (ROP), cerebral palsy [24], delayed growth [11], and increased mortality rate [6,34,45,[47][48][49][50].…”

Right‐sided infective endocarditis in patients with uncorrected ventricular septal defect and patent ductus arteriosus: Two case reports

“…The incidence of IE among ventricular septal defects (VSD) was 0.2%‐2% 2, 3. In patent ductus arteriosus (PDA), the risk for developing IE is lower as compared to patients with VSD 4. The presence of both defects concomitantly may increase the risk for IE, especially in patients with uncorrected defects.…”