In this episode, we review patent ductus arteriosus (PDA), a common congenital heart defect characterized by persistent connection between the aorta and pulmonary artery, resulting in a left-to-right shunt and pulmonary overcirculation. We break down the underlying physiology of failed ductal closure after birth, including the roles of oxygen tension and prostaglandins, and discuss why premature infants are at highest risk. Clinically, we highlight presentations ranging from asymptomatic small PDAs to larger defects causing tachypnea, poor feeding, failure to thrive, and signs of heart failure. Classic exam findings—especially the continuous "machinery" murmur and bounding pulses—are emphasized alongside diagnostic confirmation with echocardiography. Management strategies include NSAID therapy (indomethacin or ibuprofen) in preterm infants and catheter-based or surgical closure for persistent or symptomatic cases. Key pearls focus on early recognition to prevent complications such as pulmonary hypertension, Eisenmenger syndrome, and heart failure.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Sathanandam S, Gutfinger D, O'Brien L, et al. Patent ductus arteriosus: current management strategies. Journal of the American College of Cardiology. 2020;75(22):2927–2938
3. Benitz WE. Patent ductus arteriosus in preterm infants. Pediatrics. 2020;146(2):e20201209
4. Backes CH, Rivera BK, Bridge JA, et al. Contemporary management of patent ductus arteriosus. Journal of Perinatology. 2021;41(2):273–282.