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Management Of PDA

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persistant ductus arteriosus and it's management

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Management Of PDA

  1. 1. Management of Patent Dactus Arteriosus Presented by Dr. Paul Shubhra Prakash
  2. 3. There are 3 options for the treatment of PDA: <ul><li>Medical management </li></ul><ul><li>Catheter based procedure </li></ul><ul><li>Surgery </li></ul>
  3. 4. <ul><li>Aims of treatment: </li></ul><ul><li>To treat or prevent Heart failure. </li></ul><ul><li>To prevent infective endocarditis. </li></ul><ul><li>To prevent development of </li></ul><ul><ul><li>pulmonary vascular disease . </li></ul></ul>
  4. 5. <ul><li>Medical management: </li></ul><ul><li>Conservative management: </li></ul><ul><li>a. Fluid restriction </li></ul><ul><li>b. Diuretic theraphy </li></ul><ul><li>c. Adequate calorie </li></ul><ul><li>d. Ventilator support </li></ul><ul><li>2 . Drugs: </li></ul><ul><li>Indomethacin </li></ul><ul><li>Ibuprofen </li></ul>
  5. 6. Indications of drugs: <ul><li>Prophylactic: </li></ul><ul><li>Dose: 0.1 mg/kg/dose 24 hourly for 6 days </li></ul><ul><li>Timing: usually within 1 st 24 hours of life. </li></ul><ul><li>Indication: All infant <1250gm birth weight who have respiratory distress. </li></ul>
  6. 7. <ul><li>Therapeutic: </li></ul><ul><li>Timing: usually within 1 st 14 days of life. </li></ul><ul><li>Indications: </li></ul><ul><li>1. If there is any clinical sign of PDA In preterm baby. </li></ul><ul><li>2.There are signs of overt failure or congestive cardic failure. </li></ul><ul><li>3. Re-treatment after failure of the first course indomethacin </li></ul><ul><li>4. Rcurrence of PDA after first course of indomethacin </li></ul>
  7. 8. <ul><li>Dose of Indomethacin: </li></ul><ul><li>O.2mg/kg stat followed by </li></ul>0.2 mg/kg/dose 12 hourly for 2 doses >7days and birth weight >1250gm 0.1 mg/kg/dose 12 hourly for 2 doses <7days and birth weight <1250gm
  8. 9. <ul><li>Adverse effect: </li></ul><ul><li>Renal dysfunction </li></ul><ul><li>Gastro-Intestinal bleeding </li></ul><ul><li>Thrombocytopenia </li></ul><ul><li>Periventricular Leucomalasia </li></ul><ul><li>Contra-indication: </li></ul><ul><li>Serum creatinine>1.8 mg/dl </li></ul><ul><li>Renal or Gastrointestinal bleeding </li></ul><ul><li>NEC </li></ul><ul><li>Sepsis </li></ul>
  9. 10. <ul><li>Dose of Ibuprofen: </li></ul><ul><li>Initial dose of 10mg/kg followed at 24 hour intervals by two doses of 5mg/kg . </li></ul><ul><li>As Ibuprofen has less Adverse effect than Indomethacin, So Ibuprofen is superior than Indomethacin. </li></ul>
  10. 11. <ul><li>Catheter-based </li></ul><ul><li>Procedures: </li></ul><ul><li>Timing : usually done after </li></ul><ul><li>neonatal period </li></ul>
  11. 12. <ul><li>Indications: </li></ul><ul><li>Small PDA with intra vascular coils. </li></ul><ul><li>Moderate to Large PDA with a catheter </li></ul><ul><li>introduced sac into which several coils </li></ul><ul><li>are released or with an umbrella-like </li></ul><ul><li>device. </li></ul>
  12. 13. Device used in Catheter-Based Procedures:
  13. 14. <ul><li>Catheter procedure: </li></ul><ul><li>Sedation </li></ul><ul><li>A small incision is given in the inner thigh </li></ul><ul><li>A long, thin, flexible, hollow tube is inserted through the femoral vein </li></ul><ul><li>Implantation of device to PDA through tube. </li></ul>
  14. 15. Catheter based procedure:
  15. 16. <ul><li>Catheter based procedure: </li></ul>
  16. 17. Surgery: <ul><li>Indications: </li></ul><ul><li>A Premature or Full-term infant with </li></ul><ul><li>symptomatic heart failure from the PDA in </li></ul><ul><li>whom medical treatment has failed or in </li></ul><ul><li>whom there is a contraindication to the </li></ul><ul><li>use of drugs. </li></ul><ul><li>A PDA isn’t successfully closed by a </li></ul><ul><li>Catheter-based Procedure. </li></ul><ul><li>Surgery is planned for treatment of related </li></ul><ul><li>Congenital heart defects. </li></ul>
  17. 18. <ul><li>Timing: Usually after 6 months of </li></ul><ul><li>age. </li></ul><ul><li>Procedure : </li></ul><ul><li>Ligation and division of ductus via a </li></ul><ul><li>Thoracotomy. </li></ul>
  18. 19. <ul><li>Complications: </li></ul><ul><li>Bleeding </li></ul><ul><li>Pneumothorax </li></ul><ul><li>Chylothorax </li></ul><ul><li>Infection </li></ul><ul><li>Thoracic scoliosis </li></ul>
  19. 20. Surgical repair of PDA:
  20. 21. Surgery of PDA
  21. 22. Thank You

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