Heart Lesions (Ductal Dependent)

What are ductal dependent heart lesions?

Ductal dependent heart lesions are birth defects (or "lesions") of the heart. "Ductal" refers to the ductus arteriosus, a blood vessel that babies have before they are born. This blood vessel lets some blood bypass the lungs. It normally closes right after birth because it is not needed anymore.

However, with some birth defects the baby still needs the ductus arteriosus after birth. These defects are called "ductal dependent" because the baby's life depends on keeping the duct open with medicine. The birth defect may block the flow of blood out of the left or right side of the heart, or the blood vessels that connect the heart and lungs may not be connected the way they should be.

There are several kinds of ductal dependent lesions:

• Pulmonary stenosis (narrowing of the pulmonary valve in the heart) or pulmonary artresia (the pulmonary valve cannot open)
• Coarctation of the aorta (a problem with the big artery that goes from the heart to the body (the aorta) is so narrow that it makes it hard for the blood to flow from the heart to the lower part of the body.)
• Transposition of the great arteries (when the 2 main arteries of the heart are reversed)
• Tetrology of Fallot (a hole between heart chambers, and narrow pulmonary valve or arteries that do not get enough blood to the lungs).
• Interrupted aortic arch (part of the aorta is missing)
• Pulmonary atresia (a valve in the heart that cannot open)

What is the cause?

The cause of ductal dependent heart lesions is unknown.

What are the symptoms?

Symptoms of ductal dependent heart lesions include:

• not feeding well
• being weak
• having a fast heartbeat
• having trouble gaining weight
• being short of breath
• sweating when they feed or cry
• turning blue
• breathing rapidly

If the baby gets worse, they can turn very cool, pale or mottled, stop urinating, and have a very weak pulse. Babies can die if not treated.

How is it diagnosed?

A healthcare provider will review your child's symptoms, ask about medical history, and examine your child. Your child may have one or more of these tests:

• echocardiogram, a special test that uses sound waves to create a picture of the heart
• chest X-ray
• heart catheterization may be done to get a more exact idea of the heart's structure before surgery. A cardiac catheterization is a procedure in which a thin tube is passed through a blood vessel to check the heart.

How is it treated?

Babies with ductal dependent lesions get medicine to keep the ductus arteriosus open for a few days until surgery can be done. Surgery is needed to correct the problems in the baby's heart.

When should I call my child's healthcare provider?

After your child comes home from the hospital, call IMMEDIATELY if your baby has:

• a fever
• redness, swelling, pain, or drainage from the incision
• shortness of breath
• swelling of the legs or ankles
• trouble moving his or her arms or legs
• been acting very sick

Call during office hours if:

• You have other questions or concerns.