Persistent ductus arteriosus: closure and maintenance of patency
THE CONTEXT
Management depends on shunt significance, pulmonary resistance, ductal structure and whether ductal flow supports lung perfusion.
Device closure and timing
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A persistent ductus can be closed during cardiac catheterisation using an implantable occlusive device.
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A significant shunt should be closed in infancy if pulmonary resistance is not elevated.
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Closure may be delayed until later childhood for smaller shunts, but remains advisable to reduce endocarditis risk.
Drug treatment
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For a structurally intact ductus, the prostaglandin synthetase inhibitors indomethacin or ibuprofen may induce closure during the first week of life.
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When a congenital defect impairs lung perfusion, as in severe pulmonary stenosis with left-to-right ductal flow, prostaglandin treatment may maintain ductal patency and improve oxygenation.
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These drug treatments do not work if the ductus is intrinsically abnormal.