PATENT DUCTUS ARTERIOSUS

The ductus arteriosus is a normal fetal connection between the left PA and the
descending aorta. During fetal life, blood flow is shunted away from the lungs
through the ductus arteriosus and directly into the systemic circulation. PDAs are
common in premature neonates who weigh less than 1,500 g. They account for 5% to
10% of !Ds, e"cluding premature neonates.
Pathophysiology and Etiology
During fetal life, the ductus arteriosus allows blood to bypass the pulmonary
circulation #fetus recei$es o"ygen from the placenta% and flow directly into the
systemic circulation.
After birth, the ductus arteriosus is no longer needed. &unctional closure
usually occurs within '( hours after birth. Anatomic closure is completed by
age ) to * wee+s.
,hen the ductus arteriosus fails to close, blood from the aorta #high pressure%
flows into the low-pressure PA, resulting in pulmonary o$ercirculation.
.ncreased pulmonary blood flow leads to a $olume-loaded /0.
Clinical Presentation
1mall to 2oderate-1i3ed PDA
4sually asymptomatic.
/arge PDA
!&, tachypnea, fre5uent respiratory tract infections.
Poor weight gain, failure to thri$e.
&eeding difficulties.
Decreased e"ercise tolerance.
Diagnostic Evaluation
Auscultation6 continuous murmur heard best at left upper sternal border.
!yperacti$e precordium with large PDAs.
,ide pulse pressure7 bounding pulses.
hest 8-ray6 $aries7 normal or cardiomegaly with increased pulmonary
$ascular mar+ings.
9:6 $aries7 normal or /0!.
Two-dimensional echocardiogram with Doppler study and color flow mapping
to $isuali3e the PDA with left-to-right blood flow.
ardiac catheteri3ation is not needed for the initial diagnosis.
Manageent
.n the symptomatic premature neonate6 indomethacin gi$en ..0.
2edical management6
o 2onitor growth and de$elopment.
o ;eassess for spontaneous PDA closure.
o .ncrease caloric inta+e as needed for normal weight gain.
o Diuretics6 furosemide #/asi"%, spironolactone #Aldactone%.
o .nfecti$e endocarditis prophyla"is for < months after surgery or coil
occlusion.
ardiac catheteri3ation6
o &or small PDAs coil occlusion.
o &or larger PDAs a closure de$ice may be used.
1urgical management through PDA ligation.
Coplications
!&, pulmonary edema.
.nfecti$e endocarditis.
Pulmonary hypertension=pulmonary $ascular occlusi$e disease.
;ecurrent pneumonia.