Patent Ductus Arteriosus


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Patent Ductus Arteriosus

  1. 1. Patent Ductus Arteriosus Dr. Kalpana Malla MBBS MD (Pediatrics) Manipal Teaching HospitalDownload more documents and slide shows on The Medical Post [ ]
  2. 2. Patent ductus arteriosus • Persistence of ductus arteriosus • Closes spontaneously in normal term infants at 3-5 days of age
  3. 3. Patent ductus arteriosus• 5-10 % of CHDs• More common in premature infants• Male: female ratio is 1:3• Higher incidence of PDA in infants born at high altitudes (> 10,000 feet)
  4. 4. Patent Ductus Arteriosus (PDA)• Usually closes within 24 to 72 hours after birth• Closure of the ductus may be delayed, or not occur at all in preterm infants• Patent PDA causes ↑pulmonary blood flow, pulmonary congestion, ↑ workload of the RV→ ↑pulmonary venous return and ↑workload of the RV
  5. 5. Hemodynamics• L→R shunt from aorta to PA• Flow occurs both in systole & diastole as pressure gradient + throughout cardiac cycle b/t two arteries- continuous murmur• Systolic as well as diastolic overloading of pul artery• To lungs → Lt atrium (enlarges)• To normal mitral valve –accentuated S1 ,mitral delayed diastolic murmur
  6. 6. • To Lt ventricle during diastole – diastolic overloading (LV enlarges)- prolongation of Lt ventricle systole-delayed closure of aortic valve late A2
  7. 7. C/F• Depend on size of the shunt and the degree of associated pulmonary hypertension• Asymptomatic if small ductus• Large ductus – frequent lower RTIs CHF poor weight gain
  8. 8. Physical examination• Tachycardia• Exertional dyspnea• Hyperactive precordium• Bounding peripheral pulses with wide pulse pressure• Systolic thrill at upper left sternal border
  9. 9. Physical findings• Auscultation: P2 normal or accentuated,• Rough grade 1-4/6 continuous murmur “machinery” murmur at left infraclavicular or upper LSB which peaks at S2 and fades before the S1
  10. 10. Ductus arteriosus
  11. 11. Investigations:1. CXR: N to cardiomegaly , increased pulmonary vascular markings2. ECG: N or LVH , BVH in large shunts, RVH with development of pulmonary vascular obstructive disease3. Echo: presence of PDA, size of cardiac chambers
  12. 12. Management:• Medical:• Indomethacin ineffective in term infants• In preterm infants indomethacin is used (80- 90% success in infants > 1200 grams) non- surgical closure• Subacute bacterial endocarditis prophylaxis
  13. 13. • Surgical closure:• Surgical correction when the PDA is large except in patients with pulmonary vascular obstructive disease• Transcatheter closure of small defects has become standard therapy
  14. 14. Natural history:• Spontaneous closure unlikely in full term infants• CHF & recurrent chest infections if large shunt• Infective endocarditis• Pulmonary vascular obstructive disease if PAH is untreated• PDA aneurysm may develop, rarely
  15. 15. AV Canal• Includes: – ASD – VSD – Abnormalities of the Mitral and/or Tricuspid valves• Greater incidence in children with Down’s Syndrome
  16. 16. Thank youDownload more documents and slide shows on The Medical Post [ ]