Pda Part 6 Treatment

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PDA

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Pda Part 6 Treatment

  1. 1. Dr. Abu Sayed Munsi Management of Patent Ductus Arteriosus Presented by
  2. 2. <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>Aims of treatment:
  3. 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>Surgical intervention </li></ul>
  4. 4. <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>Drugs: </li></ul><ul><li>Indomethacin </li></ul><ul><li>Ibuprofen </li></ul>Medical management:
  5. 5. Indications of drug : <ul><li>Prophylactic: </li></ul><ul><li>Indication: </li></ul><ul><li>All infant <1250gm birth weight who have respiratory distress. </li></ul><ul><li>Timing: </li></ul><ul><li>Usually within 1 st 24 hours of life. </li></ul><ul><li>Dose: </li></ul><ul><li>0.1 mg/kg/dose 24 hourly for 6 days. </li></ul>
  6. 6. <ul><li>Therapeutic: </li></ul><ul><li>Timing : </li></ul><ul><li>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 cardiac failure. </li></ul><ul><li>3. Re-treatment after failure of the first course indomethacin. </li></ul><ul><li>4. Recurrence of PDA after first course of indomethacin. </li></ul>
  7. 7. <ul><li>Indomethacin: </li></ul>Dose: O.2 mg/kg stat followed by <7days and birth weight <1250gm 0.1 mg/kg/dose 12 hourly for 2 doses >7days and birth weight >1250gm 0.2 mg/kg/dose 12 hourly for 2 doses
  8. 8. <ul><li>Adverse effects: </li></ul><ul><ul><li>Renal dysfunction </li></ul></ul><ul><ul><li>Gastro-Intestinal bleeding </li></ul></ul><ul><ul><li>Thrombocytopenia </li></ul></ul><ul><ul><li>Periventricular Leucomalasia </li></ul></ul><ul><li>Contra-indication: </li></ul><ul><ul><li>Serum Creatinine >1.8 mg/dl </li></ul></ul><ul><ul><li>Renal or gastro-intestinal bleeding </li></ul></ul><ul><ul><li>NEC </li></ul></ul><ul><ul><li>Sepsis </li></ul></ul>
  9. 9. <ul><li>Ibuprofen: </li></ul><ul><li>Dose: </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. 10. <ul><li>Catheter-based Procedures: </li></ul>
  11. 11. <ul><li>Timing: </li></ul><ul><li>Usually done after neonatal period </li></ul><ul><li>Catheter procedures available </li></ul><ul><ul><li>Small PDA with intra vascular coils. </li></ul></ul><ul><ul><li>Moderate to Large PDA with a catheter introduced sac into which several coils are released or with an umbrella-like device. </li></ul></ul>
  12. 12. Device used in Catheter-Based Procedures:
  13. 13. <ul><li>Trans Catheter </li></ul><ul><li>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. 14. Surgical Intervention: <ul><li>Indications: </li></ul><ul><li>A Premature or Full-term infant with </li></ul><ul><li>symptomatic heart failure from the PDA </li></ul><ul><li>in whom medical treatment has failed or </li></ul><ul><li>in whom there is a contraindication to </li></ul><ul><li>the 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>Large PDA which is unsuitable for Trans </li></ul><ul><li>catheter closure. </li></ul>
  15. 15. <ul><li>Timing: </li></ul><ul><li>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 Thoracotomy. </li></ul>
  16. 16. <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>
  17. 17. Surgical repair of PDA
  18. 19. Thank You

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