Patent ductus arteriosus: Difference between revisions

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==Background==
==Background==
*Abbreviation: PDA
*Ductus arteriosus is a blood vessel connecting main pulmonary artery to proximal descending aorta
*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.<ref>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.</ref>
**Shunts blood from right ventricle to bypass fetus's non-functioning lungs in utero
*In PDA, ductus fails to close after birth
*Second most common congenital heart disease
*Approximately 1 in 1600 to 5000 live births in the US.<ref>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.</ref>


===Pathophysiology===
===Pathophysiology===
[[File:PDA.png|thumb]]
[[File:PDA.png|thumb]]
*Ductus arteriosus shunts blood from the pulmonary artery to the aorta bypassing the lungs while in utero
*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. 
*Normally closes soon after birth via complex process
*In a PDA, the vessel fails to close, resulting in shunting of blood between the aorta and the pulmonary artery. 
**Regulated by oxygen tension and decreases in prostaglandin E2
*This shunting allows some oxygenated blood from the aorta, which has a higher pressure, to the pulmonary artery, which has the lower pressure.
**Becomes ligamentum arteriosum
*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.
*In PDA, ductus fails to close
*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.
**Results in shunting of blood between aorta and pulmonary artery
**Some oxygenated blood from high-pressure aorta shunts to lower pressure pulmonary artery
**A large shunt can cause increased fluid return to lungs and increased lung pressure, leading to [[pulmonary hypertension]]
*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'''.
**In these cases [[prostaglandin E1|prostaglandins]] are used to keep the ductus arteriosus '''open'''.


Revision as of 14:39, 9 March 2019

Background

  • Ductus arteriosus is a blood vessel connecting main pulmonary artery to proximal descending aorta
    • Shunts blood from right ventricle to bypass fetus's non-functioning lungs in utero
  • In PDA, ductus fails to close after birth
  • Second most common congenital heart disease
  • Approximately 1 in 1600 to 5000 live births in the US.[1]

Pathophysiology

PDA.png
  • 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
    • Becomes ligamentum arteriosum
  • In PDA, ductus fails to close
    • Results in shunting of blood between aorta and pulmonary artery
    • Some oxygenated blood from high-pressure aorta shunts to lower pressure pulmonary artery
    • A large shunt can cause increased fluid return to lungs and increased lung pressure, leading to pulmonary hypertension
  • 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

Congenital Heart Disease Types

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

  1. ↑ 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.
  2. ↑ Knipe K et al. Cyanotic congenital heart diseases. Radiopaedia. http://radiopaedia.org/articles/cyanotic-congenital-heart-disease
  3. ↑ http://www.thepocusatlas.com/pediatrics/
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