Patent Ductus Arteriosus (PDA): Definition
Abnormality that results from persistence of the foetal ductus arteriosus in the post natal period
PDA: Anatomy
Ductus arteriosusFoetal vascular structure
Originates from pulmonary confluence
Terminates in the left sided descending aorta just beyond origin of the left subclavian artery.
Serves as a conduit connecting pulmonary artery to aorta
PDA: maintenance of patency
High levels of circulatory and locally derived PGE2 and PGI2These cause relaxation of ductal smooth muscle and maintain ductal patency
O2 exerts a constrictive effect
Low Po2 in ductal blood also maintain patency.
PDA: Closure of the ductus
Changes begins at birthClosure is in two stages
Early phase
Constriction of smooth muscles in ductal wall occur in first few hours after birthTriggered by increase in ductal blood PO2 and a rapid fall in PG levels ( removal of placental source )
Late phase
Results from fibrosis of the ductus, evolves over the next few weeks.Usually completed by 8weeks of postnatal life.
PDA: Pathophysiology
Effects due to L → R shuntSmall shunt
Flow is low volume and haemodynamic effects minimalTurbulence of the high velocity jet however predisposes to infective endocarditis
Large shunt
Large increase in pulmonary blood flowSevere left ventricle volume overload → CHF
Moderate shunt
Effects are intermediatePDA: Clinical features
Small ductus
AsymptomaticIncidental finding on routine examination
Large ductus
Failure to thriveCongestive heart failure
Repeated respiratory infections
Physical examination
LV volume overloadLarge pulse pressure
Collapsing pulse
Machinery murmur in pulmonary area
PDA: Diagnosis
HistoryPhysical examination
CXR
ECG
ECHO
Cardiac catheterisation
PDA: Treatment
MedicalTreatment of CHF
Treatment of infection
Pharmacological inducement of ductal closure in preterm infants
Indomethacin 0.1 – 0.2mg/kg 8hrly x 3doses
Surgical
Open/ conventional surgical ligation
Thoracoscopic techniques
Interventional catheter techniques
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