Patent Ductus Arteroisus, PDA, Cardiology, Paediatrics, Pedicatrics, Critical Care, Emergency medicine, Medicine, Internal Medicine, MBBD, MD, India, CMC Vellore, Christian Medical College
4. Introduction
Communication between the pulmonary
artery and the aorta
Location – distal to left subclavian
F:M = 2:1
Maternal rubella, prematurity
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6.
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8. History:
Irritable, feed poorly, fail to gain weight
and sweat excessively
Increased respiratory effort and
respiratory rates
prone to develop recurrent upper
respiratory infections and pneumonia
10. Accentuated first sound and narrowly or
paradoxically split second sound (large
shunts)
Differential cyanosis and clubbing is
pesent in shunt reversal
11. What Physical Exam findingsWhat Physical Exam findings
are consistent with PDA?are consistent with PDA?
Murmur: systolic at
LUSB/Left
Infraclavicular, may
progress to continuous
(machinery)
Cardiac: Active
Precordium, Widened
Pulse Pressure, Bounding
Pulses
Respiratory Sx:
Tachypnea,
Apnea
12. Hemodynamics
Flow during both systole and diastole –
pressure gradient present throughout
(pulm artery pressure normal)
Continuous murmur
Overload of pulm artery increased
flow through left atrium and ventricle –
accentuated first sound and mitral
delayed diastolic murmur
Delayed closure of aortic valve & late
A2 (S2 may be paradoxically split)
13. Dilatation of the ascending aorta
Aortic ejection click – preceeding the
conti nuous murmur
Aortic ejection systolic murmur – drowned
by the loud continuous murmur
21. Course and Complications
Ejection systolic murmur at birth (due to
pulmonary hypertension) continuous
murmur after a few weeks
Development of Pulmonary arterial
hypertension diastolic component lost
ejection systolic murmur
Severe PAH rt to lft shunt
disappearance of the murmur and
appearance of differential cyanosis
22. Complications:
Cardiac failure
Infective endarteritis
Eisenmenger
Rare complications
-aneurysmal dilatation of the pulmonary
artery or the ductus
-calcification of the ductus
-noninfective thrombosis of the ductus
with embolization
-paradoxical emboli
23. DDX
Aorticopulmonary window defect
Ruptured sinus of valsalva aneurysm
Coronary arteriovenous fistulas
Aberrant left coronary with massive
collaterals from the right
Truncus arteriosus
VSD with aortic insufficiency
Peripheral pulmonic stenosis
Venous hum in TAPVC
25. Prophylactic indomethacin has short-term
benefits for preterm infants including a
reduction in the incidence of
symptomatic PDA, PDA surgical ligation,
and severe intraventricular haemorrhage.
However, there is no evidence of effect
on mortality or neurodevelopment.
Cochrane review 2010: Prophylactic
intravenous indomethacin for preventing
mortality and morbidity in preterm infants
Peter W Fowlie et al
26. Ibuprofen is as effective as indomethacin
in closing a PDA and currently appears to
be the drug of choice. Ibuprofen reduces
the risk of NEC and transient renal
insufficiency.
Ibuprofen for the treatment of patent
ductus arteriosus in preterm or low birth
weight (or both) infants Cochrane reviews
2015- Arne Ohlsson, Rajneesh Walia,
Sachin S Shah
27. Paracetamol appears to be a promising
new alternative to indomethacin and
ibuprofen for the closure of a PDA with
possibly fewer adverse effects.
Paracetamol (acetaminophen) for patent
ductus arteriosus in preterm and low-birth-
weight infants Cochrane review March
2015- Ohlsson A, Shah PS
28. Treatment
All patients with PDA require surgical or
catheter closure.
Rationale:
Small PDA- prevention of bacterial
endarteritis
Moderate to large PDA- to treat heart
failure or prevent the development of
pulmonary vascular disease, or both.
29. Cardiac catheterization –
Trans catheter closure
Small PDAs- closed with intravascular
coils.
Moderate to large – catheter introduced
sacs or umbrella like device