Patent ductus arteriosus

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Patent ductus arteriosus

• An overview

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DEFINITION

• Patent ductus arteriosus (PDA) is a heart problem
  that is usually noted in the first few weeks or
  months after birth. It is characterized by a
  connection between the aorta and the pulmonary
  artery, which allows oxygen-rich (red) blood that
  should go to the body to re-circulate through the
  lungs

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IN DEPTH
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IN GROSS
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HEMODYNAMICS

• LT TO RT SHUNT OCCURS BOTH DURING SYSTOLE
  DIASTOLE
• LARGE AMT OF BLOOD PASSES THRU PULM ART-LT ATRIUM
  MITRAL VALVE

• CONTINOUS MURMUR
• ACCENTUATED S1
• MITRAL DELAYED DIASTOLIC MURMUR

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HEMODYNAMICS

• LARGE FLOW THRU LT VENT-DELAYED CLOSURE OF AORTIC
  VALVE
• DILATATION OF ASCENDING AORTA

• LATE A2
• PARADOXICALLY SPLIT S2
• AORTIC EJECTION CLICK
• AORTIC EJECTION SYSTOLIC MURMUR

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PRESENTATION

• Frequent chest infections
• fatigue
• sweating
• rapid breathing
• heavy breathing
• congested breathing
• disinterest in feeding, or tiring while feeding
• poor weight gain

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ON EXAMINATION

• INSPECTION
• CAROTID PULSATIONS
• HYPERKINETIC LT VENTRICULAR TYPE OF APICAL
  IMPULSE

• PALPATION
• SYSTOLIC OR CONTINOUS THRILL AT 2ND LT INTERSPACE

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AUSCULTATION

• ACCENTUATED S1
• NARROWLY OR PARADOXICALLY SPLIT S2
• LOUD P2
• CONTINOUS/GIBSONS/TRAIN-IN-TUNNEL MURMUR BEST
  HEARD IN INFRACLAVICULAR REGION
• MITRAL DELAYED DIASTOLIC MURMUR

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CXR FINDINGS

• CARDIOMEGALY
• LA ENLARGEMENT
• LV ENLARGEMENT
• PROMINENT AORTIC KNUCKLE
• PULM PLETHORA

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ECG CHANGES

• NORMAL AXIS WITH LT VENTRICULAR HYPERTROPHY

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ECHO PICTURES
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MANAGEMENT

• MEDICAL
• INDOMETHACIN 0.1 mg/kg/dose,orally,bd for three
  doses
• Digoxin for increasing working capacity of heart
• Diuretics to reduce preload on heart

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SURGICAL REPAIR DEVICES
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REPAIR