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Patent Ductus Arteriosus (Etiology (Condition (High elevations (Children…

- - - - Sixth branchial arch
      - in the six week of gestation
- - - - Low pO2 in fetal
        
        Prevent calcium influx
        
        Prevent smooth muscle contraction
      - Higher pO2 promote vasoconstriction
    - - Relax ductal smooth muscle
      - Types
        
        Endogenous
        
        PGI2
        
        PGE2
        
        Larger role
        
        Exogenous
        
        PGE1
    - - Nitric oxide
      - Adenosine
  - - - Persistently low arterial pO2
        
        Due to
        
        Persistently elevated pulmonary vascular resistance --> R-L shunt
        
        Premature ductus - less responsive to the vasoconstrictive effect of O2
        
        PGE2 primarily metabolized in lung --> premature lung --> Higher PGE2
        
        Immature lungs - Poor Alveolar-capillari O2 diffusion
    - - Children born in high altitude --> Higher PDA prevalence (30x normal)
      - Due to decreased ambient O2 conc
    - - Ductal-dependent cyanotic and obstructive defects
        
        May constrict even in severe cyanosis
      - Due to decreased ductal blood pO2
    - - Constellation of congenital abnormalities
        
        Growth retard (ec Placental insuf)
        
        Deafness
        
        Cataracts
        
        CHD
        
        Neonatal purpura + Thrombocytopenia
  - - - Consanguinity
      - Vertical recessive gene
    - - Heart-hand syndrome (Holt-Oram syndrome) + PDA
      - Characteristic
        
        Typical facial features
        
        Short philtrum
        
        Prominent lips
        
        Flattened nasal bridges
        
        Upturned nose
        
        abnormalities of the fifth finger
- - - - Caused by: Smooth muscle contraction
      - Within 24-72 hours of life
      - Can still be re-opened by PGE1
    - - Functional closure -> smooth muscle contraction -> Hypoxia inner layer of ductus
      - Hypoxia --> Cell destruction and fibrosis
      - Left out: ligamentum arteriosus
- - - - Symptomatic: more than 5 kg
      - Mildly sympotatic --> weight >7-8 kg
    - - Large PDA
        
        Contrast 2cc/kg contrast over 1-2s to delineate PDA morphology
      - Choosing Ductal occluder size
        
        at least 4 mm larger
        
        6 mm larger in PDA-PH
    - - Teeth Management
      - Antibiotic control