Patent ductus arteriosus

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

Last reviewed: 5 Aug 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 haemodynamic 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

presence of risk factors
presentation in infancy

Full details

Other diagnostic factors

tachypnoea/shortness of breath (SOB)
faltering growth
exercise intolerance
widened pulse pressure
machine-like continuous murmur/Gibson murmur in children born at full-term
apnoea
low diastolic blood pressure (BP)
irritability
diaphoresis
increased respiratory symptoms with upper respiratory tract 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 catheterisation and angiography

Full details

Treatment algorithm

INITIAL

premature very low birth weight infants: prophylactic therapy

ACUTE

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

Contributors

Authors

Kenneth M. Coca, MD

Pediatric Cardiology Fellow

Johns Hopkins All Children’s Hospital

Saint Petersburg

Disclosures

KMC declares that he has no competing interests.

Joyce T. Johnson, MD, MS

Director, Fetal Cardiology

Johns Hopkins All Children’s Hospital

Saint Petersburg

Disclosures

JTJ declares that she has no competing interests.

Acknowledgements

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.

Disclosures

ATY declares that she has no competing interests.

Peer reviewers

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

Acting Head

Department of Cardiology

Royal Children's Hospital

Melbourne

Australia

Disclosures

MC declares that he has no competing interests.

Rajat Bhatt, MD

Assistant Professor

Internal Medicine

Texas Tech University Health Sciences Center (TTUHSC)

Lubbock

Disclosures

RB declares that he has no competing interests.

Henry M. Sondheimer, MD

Professor of Pediatrics

Clinical Director

Pediatric Cardiology

The Children's Hospital

Denver

Disclosures

HMS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text

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

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.Full text Abstract

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.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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

Treatment algorithm

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

Contributors

Authors

Kenneth M. Coca, MD

Disclosures

Joyce T. Johnson, MD, MS

Disclosures

Acknowledgements

Disclosures

Peer reviewers

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

Disclosures

Rajat Bhatt, MD

Disclosures

Henry M. Sondheimer, MD

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

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