Patent Ductus Arteriosus: A Diagnostic and Treatment Dilemma

Ductus arteriosus is a critically important vascular structure that functions as an extracardiac shunt in fetal life between the pulmonary and systemic circulations for optimal utilization of the placenta as a gas exchange organ and fetal well-being. While morbidities and mortality are well known to be associated with persistence of patent ductus arteriosus (PDA) in postnatal life, the treatment options have concerns for adverse outcomes. Additionally, high spontaneous closure rates, lack of clear definition of hemodynamically significant PDA (hs-PDA), ideal diagnostic tools, conflicting evidence regarding timing of treatment, and lack of clear benefits of PDA treatment from randomized trial in reducing adverse outcomes continue to pose challenges for clinicians managing preterm infants with PDA. This review focuses on the pathophysiology, current diagnostic and management practices, as well as the potential of utilizing unique diagnostic tools to support precision medicine for preterm infants with hs-PDA.