PATENT DUCTUS ARTERIOSUS

 Persistence of the normal fetal vessel that joins the Pulmonary artery to the Aorta.
 Normally closes in the 1st wk of life.
 Female: Male ratio of 2:1
 associated with maternal rubella infection during early pregnancy
 PDA is a common problem in premature infants.
 As a result of higher aortic pressure, blood shunts L to R through the ductus from Aorta to PA
PDA: Manifestations
 A small PDA is usually asymptomatic.
 Tachycardia
 Shortness of breath
 Retardation of physical growth.
 Characteristic systolic-diastolic murmur at the base of the heart with maximum in the PA
 Classic continuous machine-like murmur
 It begins soon after onset of the 1st sound, reaches maximal intensity at the end of systole, and
wanes in late diastole.
 Prominent apical impulse
 Enlarged heart
 Left sub clavicular thrill
 Bounding pulse
 
MANGEMENT:
 An infant may be prescribed IV indomethacin or ibuprofen, prostaglandin inhibitors
 These lower the PGE1 level and encourage ductus closure
 Because it has much fewer side effects, ibuprofen is becoming the drug of choice; it can even be
used as prophylaxis in preterm infants
 If medical management fails to bring about closure of the ductus arteriosus, the disorder can be
closed by insertion of Dacron-coated stainless-steel coils by interventional cardiac catheterization
when the child is 6 months to 1 year of age.
 Exceptionally large defects can be closed surgically by ductal ligation. This involves major surgery
because opening the chest (thoracotomy) and manipulating the great vessels is necessary.
 If surgery is not done by one of these techniques, the child is at risk for heart failure from the
increased amount of blood pouring back into the pulmonary artery and infectious endocarditis
developing from the recirculating blood and potential stasis in the pulmonary artery.