Patent ductus arteriosus: Difference between revisions
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===Pathophysiology=== | ===Pathophysiology=== | ||
[[File: | [[File:PDA.png|thumb]] | ||
* | *Ductus arteriosus shunts blood from the pulmonary artery to the aorta bypassing the lungs while in utero | ||
* | *Normally closes soon after birth via complex process regulated by oxygen tension and decreases in prostaglandin E2. | ||
*In a PDA, the vessel fails to close, resulting in | *In a PDA, the vessel fails to close, resulting in shunting of blood between the aorta and the pulmonary artery. | ||
*This shunting | *This shunting allows some oxygenated blood from the aorta, which has a higher pressure, to the pulmonary artery, which has the lower pressure. | ||
*Some congenital heart defects, such as transposition of the great | *If the shunt is large enough, can cause increase fluid return to the lungs, increased lung pressure, and thus increased energy demands to fill the lungs. | ||
*Some congenital heart defects, such as [[transposition of the great arteries]], are incompatible with life ''''without''' a PDA; may be necessary to allow oxygenated and deoxygenated blood to mix. | |||
**In these cases [[prostaglandin E1|prostaglandins]] are used to keep the ductus arteriosus '''open'''. | |||
==Clinical Features== | ==Clinical Features== | ||
* Continuous machine like [[ | * Continuous machine like heart [[murmur]] | ||
* Differential cyanosis (cyanosis of lower extremities and not the upper extremities) | * Differential cyanosis (cyanosis of lower extremities and not the upper extremities) | ||
* [[Dyspnea]] | * [[Dyspnea]] | ||
* [[Tachycardia]] | * [[Tachycardia]] | ||
* Widened | * Widened pulse pressure | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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[[File:PDA Fomani.gif|thumbnail|Echocardiography demonstrating PDA<ref>http://www.thepocusatlas.com/pediatrics/</ref>]] | [[File:PDA Fomani.gif|thumbnail|Echocardiography demonstrating PDA<ref>http://www.thepocusatlas.com/pediatrics/</ref>]] | ||
* Careful physical examination demonstrating characteristic machine like murmur | * Careful physical examination demonstrating characteristic machine like murmur | ||
* Echocardiography | * [[Echocardiography]] | ||
*Laboratory tests are usually not helpful. MRA and Cardiac CT can also be used as diagnostic tools | *Laboratory tests are usually not helpful. MRA and Cardiac CT can also be used as diagnostic tools | ||
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=== Medical Therapy === | === Medical Therapy === | ||
*IV [[indomethacin]] | *IV [[indomethacin]]: usually effective when administered in the first 10-14 days of life. | ||
=== Surgical Therapy: === | === Surgical Therapy: === | ||
Revision as of 19:30, 27 January 2019
Background
- Abbreviation: PDA
- A condition where the ductus arteriosus does not close after birth. It is the second most common congenital heart disease affecting approximately 1 in 1600 to 5000 live births in the US.[1]
Pathophysiology
- Ductus arteriosus shunts blood from the pulmonary artery to the aorta bypassing the lungs while in utero
- Normally closes soon after birth via complex process regulated by oxygen tension and decreases in prostaglandin E2.
- In a PDA, the vessel fails to close, resulting in shunting of blood between the aorta and the pulmonary artery.
- This shunting allows some oxygenated blood from the aorta, which has a higher pressure, to the pulmonary artery, which has the lower pressure.
- If the shunt is large enough, can cause increase fluid return to the lungs, increased lung pressure, and thus increased energy demands to fill the lungs.
- Some congenital heart defects, such as transposition of the great arteries, are incompatible with life 'without a PDA; may be necessary to allow oxygenated and deoxygenated blood to mix.
- In these cases prostaglandins are used to keep the ductus arteriosus open.
Clinical Features
- Continuous machine like heart murmur
- Differential cyanosis (cyanosis of lower extremities and not the upper extremities)
- Dyspnea
- Tachycardia
- Widened pulse pressure
Differential Diagnosis
- Acute pericarditis
- Aortopulmonary Septal Defect
- Coarctation of the Aorta
- Coronary Artery Fistula
- Pediatric Acute Respiratory Distress Syndrome
- Pediatric Sinus of Valsalva Aneurysm
- Pediatric Tachycardia
- Pulmonic Valvular Stenosis
- Sickle cell anemia
- Tetralogy of Fallot With Absent Pulmonary Valve
Congenital Heart Disease Types
- Cyanotic
- Acyanotic
- AV canal defect
- Atrial septal defect (ASD)
- Ventricular septal defect (VSD)
- Cor triatriatum
- Patent ductus arteriosus (PDA)
- Pulmonary/aortic stenosis
- Coarctation of the aorta
- Differentiation by pulmonary vascularity on CXR[2]
- Increased pulmonary vascularity
- Decreased pulmonary vascularity
- Tetralogy of fallot
- Rare heart diseases with pulmonic stenosis
Evaluation
Echocardiography demonstrating PDA[3]
- Careful physical examination demonstrating characteristic machine like murmur
- Echocardiography
- Laboratory tests are usually not helpful. MRA and Cardiac CT can also be used as diagnostic tools
Management
- Spontaneous closure is usually common but if significant respiratory distress or impaired oxygen delivery is present, therapy is usually required.
Medical Therapy
- IV indomethacin: usually effective when administered in the first 10-14 days of life.
Surgical Therapy:
Cardiac catheterization and catheter closure in addition to surgical ligation are also options if medical therapy fails.
Disposition
See Also
External Links
References
- ↑ Mitchell, S. C., Korones, S. B., Berendes, H. W. Congenital heart disease in 56,109 births: incidence and natural history. Circulation 43: 323-332, 1971.
- ↑ Knipe K et al. Cyanotic congenital heart diseases. Radiopaedia. http://radiopaedia.org/articles/cyanotic-congenital-heart-disease
- ↑ http://www.thepocusatlas.com/pediatrics/