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Management Of PDA

There are three main options to treat a patent ductus arteriosus (PDA): medical management using drugs like indomethacin or ibuprofen, catheter-based procedures to implant occlusion devices, or surgery to ligate and divide the ductus. Medical management aims to treat or prevent heart failure, infective endocarditis, and pulmonary vascular disease. Catheter procedures are usually done after the neonatal period for moderate to large PDAs. Surgery is indicated if medical treatment fails or for treatment of related congenital heart defects, and involves ligating and dividing the ductus via thoracotomy.

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