Patent ductus arteriosus (PDA) continues to be a significant finding among infants, as well as adults. What is widely considered to be a problem though, in a group of patients with congenital heart disease, it is the only lifeline. We will initially study the anatomical and biochemical mechanisms affecting the PDA. The main focus of this review is on ductal-dependent congenital heart disease and biochemical and pharmacological approaches to maintaining ductus arteriosus patency, as well as surgical and interventional options for maintaining circulation. The present review aims to highlight gaps in the knowledge regarding the multifunctional role of ductus arteriosus endothelium and possibly propose a new approach to pharmacological maintenance of ductus arteriosus patency.