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After the defects are repaired, the doctor will prescribe antibiotics for the child to take before having any dental work or surgery to prevent a bacterial infection of the heart. After surgery, the child will grow and develop normally, but he or she will need to be examined regularly throughout life by a cardiologist to detect any problems (such as irregular heart rhythms) that could develop.

Patent Ductus Arteriosus

Patent ductus arteriosus is a heart defect in which a blood vessel called the ductus arteriosus fails to close after birth. This blood vessel connects the pulmonary artery (which transports blood from the heart to the lungs) and the aorta (the main artery that transports blood from the heart to the body) in the fetus. Because this blood vessel stays open (patent) after birth, some of the blood pumped from the left side of the baby’s heart flows back to the lungs instead of to the rest of the body. Through a stethoscope, a doctor will be able to hear a murmur of blood flow through the ductus. Patent ductus arteriosus occurs most often in premature infants but also can occur in full-term babies.

Patent ductus arteriosus

A fetus’s heart has a channel called the ductus arteriosus, which connects the pulmonary artery and the aorta. Because the fetus receives oxygen from the mother’s placenta and umbilical cord, the channel allows blood to bypass the lungs. Normally, the channel closes shortly after birth to allow blood to flow to the lungs to receive oxygen. In patent ductus arteriosus, the channel stays open (patent), allowing oxygenated blood to flow back from the aorta through the pulmonary artery to the baby’s lungs, making the heart work extra hard.

Symptoms

A small opening in the ductus arteriosus often causes no symptoms or only mild symptoms. A large opening can cause an infant to breathe rapidly and have shortness of breath, a very strong pulse, difficulty feeding, poor weight gain, and frequent chest infections. He or she may also be irritable.

Diagnosis

Doctors can diagnose patent ductus arteriosus by listening for a heart murmur through a stethoscope. To confirm the diagnosis, a doctor will recommend additional tests, such as a chest X-ray, an echocardiogram (see page 561), or an electrocardiogram (see page 559).

Treatment

The doctor will first administer a medication called indomethacin intravenously (through a vein) to close the ductus in a premature infant. He or she will also give the baby diuretics to reduce the fluid levels in his or her body by increasing urination. The baby’s intake of fluids will be limited to prevent fluid buildup.

If this treatment is not successful, if the baby is full term, or if patent ductus arteriosus is diagnosed in an older infant or child, the doctor will recommend a cardiac catheterization procedure (see page 592) to close the ductus. In this procedure, the ductus is closed off with coils inserted through a thin, flexible tube (catheter) that is threaded into the heart through an artery or vein. In rare cases, surgery (performed through an incision under the left arm) is necessary to close off the ductus. Both procedures have excellent success rates; the child will have no remaining problems from the defect, and he or she will grow and develop normally.

Transposition of the Great Arteries

Transposition of the great arteries is a serious heart defect in which the two major arteries that carry blood from the heart—the aorta (which carries blood from the heart to the rest of the body) and the pulmonary artery (which carries blood from the heart to the lungs)—are reversed. As a result, deoxygenated blood returning from the body to the heart is pumped back to the body without flowing to the lungs to receive a fresh supply of oxygen. Without treatment, a baby with this heart defect is likely to die within the first few weeks of life.

Transposition of the great arteries

Transposition of the great arteries is a heart defect in which the major arteries that carry blood away from the heart—the pulmonary