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 Children's Health

August 2010
The Hole Truth
Dr Dhritabrata Das
 
When he was born, the 2.8 Kg baby Sandip Kumar Dey did seem to be healthy. But he began to lose weight pretty soon in the days ahead. The baby also developed breathing difficulties – making it difficult to feed him. The simple act of breathing while sucking the milk became quite a chore for him.

PDA
The local paediatrician’s stethoscope picked up an abnormal heart sound – something like a murmur. At our hospital, we confirmed the presence of Patent Ductus Arteriosus (PDA), an abnormal connection in between the two main blood vessels leaving the heart
PDA is twice as common in girls as it is in boys.

Tidbits about PDA 
  • When in the womb, the blood vessel called Ductus Arteriosus allows blood to bypass the baby's lungs by connecting the two major blood vessels that carry blood from the heart - the pulmonary arteries (which supply blood to the lungs), with the aorta (which supplies blood to the body). A PDA is normal for a baby inside the mother’s womb when he/she receives oxygen directly from mother and the lungs do not have to work.
  • This blood vessel is no longer required after the baby’s lungs fill with air, after its first cry. Our body is designed in such a way that this vessel will usually close within a couple of days. Patent Ductus Arteriosus causes problem when it does not close. In one out of 20,000 babies, this closure fails to occur. (‘Patent’ here means ‘open’.)
  • Left untreated, this non-closure can cause excessive blood to flow through the heart and lungs, which increases the work of both. It weakens the heart muscle and causes heart failure and other complications. Uncorrected PDA may lead to irreversible damage to the lungs.
Remember
  • A small PDA often doesn't cause symptoms. A doctor may discover it during a routine exam. Occasionally, a small PDA may not be detected until adulthood.
  • A child with PDA may have frequent lung infections.
Watch Out For These

Call on your doctor if your baby:
  • Tires easily when eating or playing
  • Is not gaining weight
  • Becomes breathless when eating or crying
  • Always breathes rapidly or is short of breath
  • Turns dusky or blue when crying or eating

Treatment

Transcatheter Device Closure:
The cardiologist passes a small metal coil or other blocking device through the catheter (a thin, hollow tube) to the site of the PDA. This blocks blood flow through the vessel. Such endovascular coils/devices have been used successfully as an alternative to surgery in many cases and the treatment of choice in present days.

Surgery:
If the catheter procedure cannot be used, the doctor resorts to surgery. A small incision is made in between the ribs to cut off the abnormal connection.

Sandip weighed only 2.8 kgs and operating on such low weight, failure-to-thrive, babies is a huge risk. But since he was not improving on the conservative treatments, our team decided to go ahead and operate on him. We cut off the PDA through a small incision on the left side of the chest. He recovered very fast and started to feed well and thus gained weight. Within few days the boy was discharged. Though he will need periodic follow up, Sandip is expected to grow normally like any other kid. 
Dr Dhritabrata Das is Consultant Paediatric Cardiologist at Apollo Gleneagles Hospitals, Kolkata


    
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