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Persistent ductus arteriosus (PDA) (Pathophysiology (Patent Pre-term…
Persistent ductus
arteriosus (PDA)
Definition
Congenital structural cardiac disorder
where the ductus arteriosus persists
after birth, leaving a connection
between the pulmonary artery and aorta
Epidemiology
12% of congenital heart disease
Pathophysiology
Patent
Pre-term infants, duct not yet closed
Becomes persistent if not closed 1m after EDD
Persistent
Term infants, failure to close by 1m
Ductus arteriosus
In foetus it connects pulmonary artery to descending aorta
Ensures that blood from RV delivered into aorta, bypassing premature lungs
Normally closes shortly after birth (1-2d)
Defective constrictor mechanism leaves it patent
As pulmonary vascular resistance falls after birth, shunt becomes L-R
Clinical
presentation
Asymptomatic
Breathlessness
(if HF)
Diagnosis
Examination
Cardio
Collapsing/bounding pulse
Murmur: continuous, ULSE
Investigations
Bloods
FBC, U+E, LFTs (baseline)
Imaging
CXR: nil (unless large with HF)
ECHO: identifies patent duct; ensures not
a duct-dependent circulation
Bedside
Obs (sats, RR, HR, BP, temp)
ECG: nil
History
PMH
Growth and development
Vaccinations
Known medical conditions
DH
Current meds, allergies
POH
Antenatal (bloods, scans, growth, complications)
Perinatal (gestation, delivery, weight, complications)
Postnatal (complications)
FH
Cardiac disorders
PC/HPC
Asymptomatic, breathless (HF)
SH
Living arrangements
Management
Conservative
Information, advice, support
Referral to cardio/paeds asap
Surgical
Surgical closure
Indication: age 1y
MOA: catheterisation with coil/device
or catheterisation
Medical
NSAID
Indication: patent; persistent before surgery
E.g. ibuprofen
MOA: inhibits PGs, encouraging duct closure
Complications
Pulmonary HTN
If large duct (rare)
Heart failure
If large duct (rare)
Infective endocarditis
Prognosis
Good if prompt treatment
at young age