Patent Ductus Arteriosus

Patent Ductus Arteriosus

Introduction 

-Embryonic ductus arteriosus allows shunting of blood from the PA to the aorta, bypassing the lungs 

-It normally closes immediately after birth 

-Failure to close results in left-to-right shunt 

-Risk factors: Down syndrome, rubella, 

Symptoms & signs 

-Usually asymptomatic at birth and during childhood 

-No symptoms in mild cases 

-Shortness of breath, sweating, almost always acyanotic but differential cyanosis can happen; lower extremities and sometimes the left hand show clubbing and cyanosis, but the right hand and head are always pink

-Continuous ‘machinery’  ‘to-and-fro’ murmur loudest over left pulmonary area below the left clavicle, widened pulse pressure, loud S2, accentuated in late systole at the time of S2, S2 is obliterated by the waxing and waning of the murmur 

Complications: Left heart dilation, pulmonary hypertension, Eisenmenger syndrome, heart failure, infective endocarditis 

Diagnosis 

Chest X-ray: normal 

ECG: normal or left atrial and ventricular hypertrophy 

Echocardiogram: left atrial and ventricular enlargement 

Treatment 

-Prior to birth, circulating prostaglandins keep the ductus patent, so a PDA can be closed by administering a prostaglandin inhibitor like indomethacin 

 Indomethacin is ineffective in term infants with PDA 

-Surgical ligation 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.