Patent ductus arteriosus An overview DEFINITION Patent ductus

Patent ductus arteriosus An overview

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

IN DEPTH

IN GROSS

HEMODYNAMICS • LT TO RT SHUNT • CONTINOUS MURMUR • • ACCENTUATED S 1 • MITRAL DELAYED OCCURS BOTH DURING SYSTOLE & DIASTOLE LARGE AMT OF BLOOD PASSES THRU PULM ART-LT ATRIUM –MITRAL VALVE DIASTOLIC MURMUR

HEMODYNAMICS • LARGE FLOW THRU • LT VENT-DELAYED CLOSURE OF AORTIC VALVE DILATATION OF ASCENDING AORTA • LATE A 2 • PARADOXICALLY SPLIT S 2 • AORTIC EJECTION • CLICK AORTIC EJECTION SYSTOLIC MURMUR

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

ON EXAMINATION • INSPECTION • CAROTID • PULSATIONS HYPERKINETIC & LT VENTRICULAR TYPE OF APICAL IMPULSE • PALPATION • SYSTOLIC OR CONTINOUS THRILL AT 2 ND LT INTERSPACE

AUSCULTATION • ACCENTUATED S 1 • NARROWLY OR PARADOXICALLY SPLIT S 2 • LOUD P 2 • CONTINOUS/GIBSONS/TRAIN-IN-TUNNEL MURMUR BEST HEARD IN INFRACLAVICULAR REGION • MITRAL DELAYED DIASTOLIC MURMUR

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

ECG CHANGES • NORMAL AXIS WITH LT VENTRICULAR HYPERTROPHY

ECHO PICTURES

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

SURGICAL REPAIR : DEVICES

REPAIR