Drug Treatment versus Catheterization
Unfortunately, there are many congenital defects, and these defects infants can affect any system in the human body, including musculoskeletal, neurological, and even dermatological.
One physiological defect an infant can be born with is Patent Ductus Arteriosus. Patent Ductus Arteriosus, or PDA, is a condition that affects blood flow to the lungs and heart.
In a normal heart, blood flows to the lungs, collecting oxygen, then travels back into the heart to be pumped out to the body. A neonate does not use their lungs to receive oxygen because the lungs are compressed and filled with amniotic fluid. It is for this reason that the ductus arteriosus exists.
The ductus arteriosus is a pathway that connects the pulmonary artery and the aortic branch. It is made of smooth muscle and is a way for the baby’s circulatory system carrying oxygen to bypass the lungs altogether.
At birth, the intake of oxygen inflates the lungs and decreases the high pressure once inside the newborn’s lungs. In a normal situation, the human body will release the hormone bradykinin, a substance that constricts the smooth muscle wall of the ductus, narrowing the space until closing off completely. Typically, this will take days, or sometimes even a few months. In an abnormal situation, the pathway remains open.
Consequences of PDA
When a PDA exists, the vessel between the aortic arch and pulmonary artery stays open and both oxygenated and deoxygenated blood mixes. There are many consequences of this condition persisting.
- Congestive heart failure
- Heart muscle damage
- Failure to thrive
- An enlarged heart from the strain of pumping excess fluid
Signs and symptoms of PDA
You or your infant’s doctor may notice some abnormal and alarming signs and symptoms with the baby such as,
- Shortness of breath due to increased fluid volume in the lungs
- Increased heart rate
- Poor eating and growth patterns
Treatment for PDA can be pharmacological or procedural, and there are benefits and risks to each.
If the PDA is mild or the baby is preterm, a drug will most likely be the first level of treatment. IV Indomethacin is a potent medication found to be highly successful in closing the ductus, blocking the enzyme cyclooxygenase which then results in the closure. However, it comes with side effects including but not limited to,
- Abnormal kidney function
- Problems with cerebral, mesenteric, and kidney blood flow
- Abnormal platelet function
- Higher risk of necrotizing enterocolitis
IV Ibuprofen, used as an alternative medication has been shown to have a positive effect on this condition. IV Ibuprofen while not as potently effective as Indomethacin, the side effects are milder.
When the PDA is more severe, or the baby does not ’t respond to drug treatment, a method using interventional cardiovascular medicine is available to correct the condition.
A specialist doctor, working under a sterilized atmosphere inserts a tiny catheter into a major artery or vein in the baby’s groin area. The catheter is threaded up the artery or vein and into the heart.
The tip of the wire holds a little metal foil that fits snugly inside the ductus. The goal of this catheterization is to block the blood flow once the metal foil is fit into the ductus.
Parents must understand that this procedure is standard, but even a minimally invasive procedure such as this one has risks. Risks of this procedure include infection and vascular puncture.
Difference of Drugs versus Catheterization
There are arguments posed for both methods of treatment, medications, and catheterization for treating PDA. Using drugs to fight it has many benefits, including:
- Lower incidence of procedure-related infections
- Less stress on the infant’s body
- No direct contact with the fragile systems of the heart
- No anesthesia required
A catheterization procedure also carries benefits:
- Higher chance of PDA closing
- Fast results
- No risk of kidney or platelet function
- No danger of necrotizing enterocolitis
As with any other health care choice, one must weigh the negatives and positives when it comes to choosing a way to close the PDA. Both drugs and interventional cardiovascular medicine have high success rates.
Specific procedures seem to rely on the patient’s age, health background, and severity of the condition. Rest assured, if your child is suffering from PDA, there is not only a way to close it, there is an army of doctors throughout the country who are skilled in performing procedures for PDA.