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This is when the tube between the aorta and the lung artery, which is normally open when the baby is growing in the womb, fails to close after the birth as it should, i.e. it remains open – or “persistent”.
It allows blood to pass from the high pressure aorta into the low pressure pulmonary artery and therefore increases the blood flow to the lungs. If the flow is small, there are no problems, if large the child will be breathless with tiredness and poor weight gain. It is common in premature babies.
If the tube (ductus) is still open more than three months, after the birth, it is unlikely to close on its own. Closure is advised in children with large tubes to reduce the workload on the heart and lungs and in small ones, to prevent the chance of infection developing in the tube (endarteritis). Many can now be closed by a catheter technique using either coils or plugs. Antibiotic prophylaxis is required for a year after implantation, then if there is no leak, may be stopped.
If the tube is large and the child small, surgical closure is often the best solution. The operation is performed through the left side of the chest without needing a heart lung machine and the tube is tied, clipped or divided. This can sometimes be performed with minimal invasive surgery (thorascopically). Circulation then returns to normal. The child may usually be discharged from follow-up with a normal heart. Antibiotic prophylaxis is then no longer required.