Patent ductus arteriosus

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 22 Sep 2025

Last updated: 23 Apr 2025

Patent ductus arteriosus (PDA) occurs when the ductus arteriosus, a vascular fetal structure that usually closes in the first 48 hours after birth, fails to close.

Persistence of the ductus arteriosus can result in heart failure, increased pulmonary pressures, and endarteritis.

The incidence and sequelae of a PDA are more significant in premature infants than infants born at full-term.

Clinical history and presentation can vary significantly depending on age of the child and the size of the ductus. Patients may be entirely asymptomatic or have signs and symptoms of heart failure and hemodynamic instability.

Treatment options vary depending on the age of the patient and the size of the ductus. Practice may vary significantly between institutions.

Definition

PDA describes the persistence of a fetal vascular structure, known as the ductus arteriosus, after birth. The ductus arteriosus connects the main pulmonary artery to the aorta, allowing blood to bypass the lungs in utero. It usually closes in the first 48 hours of life.[1]

History and exam

Key diagnostic factors

presentation in infancy

Full details

Other diagnostic factors

tachypnea/shortness of breath (SOB)
faltering growth
exercise intolerance
widened pulse pressure
machine-like continuous murmur/Gibson murmur in children born at full-term
apnea
low diastolic blood pressure (BP)
irritability
diaphoresis
increased respiratory symptoms with upper respiratory infection
murmur heard only during systole
hyperdynamic precordium
systolic thrill
third heart sound heard at apex
mid-diastolic rumble heard at apex
bounding peripheral pulses
pulmonary rales

Full details

Risk factors

prematurity
maternal rubella
female sex
respiratory distress syndrome (RDS)
high altitude
family history
black race

Full details

Diagnostic investigations

1st investigations to order

CXR
ECG
echocardiogram

Full details

Investigations to consider

cardiac catheterization and angiography

Full details

Algoritmo de tratamento

Inicial

premature very low birth weight infants: prophylactic therapy

AGUDA

premature infants (<32 weeks)

term infants and children: small-to-moderate-sized ducts

term infants and children: large ducts and/or symptomatic infants too small for device closure

adults

Colaboradores

Autores

Kenneth M. Coca, MD

Pediatric Cardiology Fellow

Johns Hopkins All Children’s Hospital

Saint Petersburg

Declarações

KMC declares that he has no competing interests.

Joyce T. Johnson, MD, MS

Director, Fetal Cardiology

Johns Hopkins All Children’s Hospital

Saint Petersburg

Declarações

JTJ declares that she has no competing interests.

Agradecimentos

Dr Kenneth M. Coca and Dr Joyce T. Johnson would like to gratefully acknowledge Dr Anji T. Yetman and Dr Nelangi M. Pinto, previous contributors to this topic.

Declarações

ATY declares that she has no competing interests.

Revisores

Michael Cheung, BSc (Hons), MB ChB, MRCP, FRACP

Acting Head

Department of Cardiology

Royal Children's Hospital

Melbourne

Australia

Declarações

MC declares that he has no competing interests.

Rajat Bhatt, MD

Assistant Professor

Internal Medicine

Texas Tech University Health Sciences Center (TTUHSC)

Lubbock

Declarações

RB declares that he has no competing interests.

Henry M. Sondheimer, MD

Professor of Pediatrics

Clinical Director

Pediatric Cardiology

The Children's Hospital

Denver

Declarações

HMS declares that he has no competing interests.

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Referências

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Principais artigos

Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC guidelines for the management of adult congenital heart disease. Eur Heart J. 2021 Feb 11;42(6):563-645.Texto completo

Hamrick SEG, Sallmon H, Rose AT, et al. Patent ductus arteriosus of the preterm infant. Pediatrics. 2020 Nov;146(5):e20201209.Texto completo Resumo

Wilson WR, Gewitz M, Lockhart PB, et al. Prevention of viridans group streptococcal infective endocarditis: a scientific statement from the American Heart Association. Circulation. 2021 May 18;143(20):e963-78.Texto completo Resumo

Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019 Apr 2;73(12):1494-563.Texto completo Resumo

John AS, Jackson JL, Moons P, et al. Advances in managing transition to adulthood for adolescents with congenital heart disease: a practical approach to transition program design: a scientific statement from the American Heart Association. J Am Heart Assoc. 2022 Apr 5;11(7):e025278.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Venous hum
- Coronary artery fistula
- Left-sided shunts (ventricular septal defect, atrioventricular septal defect)
Mais Diagnósticos diferenciais
Guidelines
- Guidelines and recommendations for performance of the fetal echocardiogram
- Pulmonary hypertension in congenital heart disease: a scientific statement
Mais Guidelines
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Patent ductus arteriosus

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Algoritmo de tratamento

premature very low birth weight infants: prophylactic therapy

premature infants (<32 weeks)

term infants and children: small-to-moderate-sized ducts

term infants and children: large ducts and/or symptomatic infants too small for device closure

adults

Colaboradores

Autores

Kenneth M. Coca, MD​

Declarações

Joyce T. Johnson, MD, MS

Declarações

Agradecimentos

Declarações

Revisores

Michael Cheung, BSc (Hons), MB ChB, MRCP, FRACP

Declarações

Rajat Bhatt, MD

Declarações

Henry M. Sondheimer, MD

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice

Kenneth M. Coca, MD