How the Heart Works

To understand patent ductus arteriosus (PDA), it helps to know how a normal heart works. Your child's heart is a muscle about the size of his or her fist. The heart works like a pump and beats 100,000 times a day.

The heart has two sides, separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body.

The heart has four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body.

A Healthy Heart Cross-Section

Figure A shows the location of the heart in the body. Figure B shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows through the heart to the lungs. The red arrow shows the direction in which oxygen-rich blood flows from the lungs into the heart and then out to the body.

Heart Chambers

The heart has four chambers or "rooms."

• The atria (AY-tree-uh) are the two upper chambers that collect blood as it flows into the heart.
• The ventricles (VEN-trih-kuhls) are the two lower chambers that pump blood out of the heart to the lungs or other parts of the body.

Heart Valves

Four valves control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart.

• The tricuspid (tri-CUSS-pid) valve is in the right side of the heart, between the right atrium and the right ventricle.
• The pulmonary (PULL-mun-ary) valve is in the right side of the heart, between the right ventricle and the entrance to the pulmonary artery. This artery carries blood from the heart to the lungs.
• The mitral (MI-trul) valve is in the left side of the heart, between the left atrium and the left ventricle.
• The aortic (ay-OR-tik) valve is in the left side of the heart, between the left ventricle and the entrance to the aorta. This artery carries blood from the heart to the body.

Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries. Then they shut to keep blood from flowing backward.

When the heart's valves open and close, they make a "lub-DUB" sound that a doctor can hear using a stethoscope.

• The first sound—the "lub"—is made by the mitral and tricuspid valves closing at the beginning of systole (SIS-toe-lee). Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
• The second sound—the "DUB"—is made by the aortic and pulmonary valves closing at the beginning of diastole (di-AS-toe-lee). Diastole is when the ventricles relax and fill with blood pumped into them by the atria.

Arteries

The arteries are major blood vessels connected to your heart.

• The pulmonary artery carries blood from the right side of the heart to the lungs to pick up a fresh supply of oxygen.
• The aorta is the main artery that carries oxygen-rich blood from the left side of the heart to the body.
• The coronary arteries are the other important arteries attached to the heart. They carry oxygen-rich blood from the aorta to the heart muscle, which must have its own blood supply to function.

Veins

The veins also are major blood vessels connected to your heart.

• The pulmonary veins carry oxygen-rich blood from the lungs to the left side of the heart so it can be pumped to the body.
• The superior and inferior vena cavae are large veins that carry oxygen-poor blood from the body back to the heart.

For more information about how a healthy heart works, go to the Health Topics How the Heart Works article. The article contains animations that show how your heart pumps blood and how your heart's electrical system works.

The Heart With Patent Ductus Arteriosus

The ductus arteriosus is a blood vessel that connects the aorta and pulmonary artery in unborn babies. This vessel allows blood to be pumped from the right side of the heart into the aorta, without stopping at the lungs for oxygen.

While a baby is in the womb, only a small amount of his or her blood needs to go to the lungs. This is because the baby gets oxygen from the mother's bloodstream.

After birth, the baby no longer is connected to the mother's bloodstream. Thus, the baby's blood must travel to his or her own lungs to get oxygen. As the baby begins to breathe on his or her own, the pulmonary artery opens to allow blood into the lungs. Normally, the ductus arteriosus closes because the infant no longer needs it.

Once the ductus arteriosus closes, blood leaving the right side of the heart no longer goes into the aorta. Instead, the blood travels through the pulmonary artery to the lungs. There, the blood picks up oxygen. The oxygen-rich blood returns to the left side of the heart and is pumped to the rest of the body.

Sometimes the ductus arteriosus remains open (patent) after birth. A PDA allows blood to flow from the aorta into the pulmonary artery and to the lungs. The extra blood flowing into the lungs strains the heart. It also increases blood pressure in the lung's arteries.

Effects of Patent Ductus Arteriosus

Full-term infants. A small PDA might not cause any problems, but a large PDA likely will cause problems. The larger the PDA, the greater the amount of extra blood that passes through the lungs.

A large PDA that remains open for an extended time can cause the heart to enlarge, forcing it to work harder. Also, fluid can build up in the lungs.

A PDA can slightly increase the risk of infective endocarditis (IE). IE is an infection of the inner lining of the heart chambers and valves.

In PDA, increased blood flow can irritate the lining of the pulmonary artery, where the ductus arteriosus connects. This irritation makes it easier for bacteria in the bloodstream to collect and grow, which can lead to IE.

Premature infants. PDA can be more serious in premature infants than in full-term infants. Premature babies are more likely to have lung damage from the extra blood flowing from the PDA into the lungs. These infants may need to be put on ventilators. Ventilators are machines that support breathing.

Increased blood flow through the lungs also can reduce blood flow to the rest of the body. This can damage other organs, especially the intestines and kidneys.

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