PATENT DUCTUS ARTERIOSUS (PDA)

CAUSATION TYPE: PATENT DUCTUS ARTERIOSUS

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Dustus arteriosus is normally present in the intrauterine life but closes soon after birth. When it does not closes, this condition develops. Maternal Rubella may account for the incidence of PDA in many eases. Here blood from the aorta is shunt to the pulmonary artery both during systole and diastole. Thus volume overload is imposed on the left ventricle as it pumps blood both into systemic and pulmonary circulation. Significant haemodynanic changes are not seen in small shunt but there is a threat to endocarditis. Moderate shunt will lead to volume load on the left atrium and ventricle with left ventricular dilatation and atrial fibrillation. Large shunt will check volume overload of left ventricle and progressive increase in pulmonary pressure and resistance leading to shunt reversal (Eisenmenger’s syndrome). So, in course of time there will be LV hypertrophy and failure and due to progressive pulmonary hypertension there will be RV hypertrophy, shunt reversal and failure. PETENT DUCTUS ARTERIOSUS (PDA)

FEATURES

  1. Female predominate.
  2. Symptoms may be absent for many years.
  3. When symptoms are present, they include dyspnoea, fatigue cardiac failure etc.
  4. Pulse may be collapsing in type, due to increased aortic run off in diastole.
  5. Left ventricular enlargement may be present.
  6. Sometimes a Mid-diastole murmur or a 3rd heart sound may be heard over the mitral area.
  7. Enlargement and sometimes abnormal pulation of the pulmonary artery may be seen in fluoroscopy. With small duct chest X-ray may be normal but with moderate shunts RV enlargement may be seen. Pulmonary truncal dilatation and peripheral pruning may be seen. Two-dimensional echocardiography from suprasternal notch is the best non-invasive investigation for demonstrating the PETENT DUCTUS ARTERIOSUS (PDA). Doppler study will be corroborative. Cardiac catheterization will help to locate the site of lesion and pulmonary to systemic floe ratio.
  8. ECG is usually normal, but may show left ventricular enlargement. Large PATENT DUCTUS ARTERIOSUS (PDA) may show enlargement of RV also.
    PETENT DUCTUS ARTERIOSU
    PETENT DUCTUS ARTERIOSUS

COMPLICATIONS:

PETENT DUCTUS ARTERIOSUS (PDA)

  1. Infective endocarditis.
  2. Congestive cardiac failure.
  3. Pulmonary hypertension with shunt reversal producing differential cyanosis.
  4. Hoarseness of voice due to pressure over recurrent laryngeal nerve.

TREATMENT:

PETENT DUCTUS ARTERIOSUS (PDA)

Triple ligation of the ductus is recommended preferable between 6 years and 10 years of age with a shunt ratio greater than 2:1. Surgical closure is reserved for large ducts (>8 mm in diameter). High pulmonary vascular resistance above 10 is a contraindication to surgery. Transcatheter device closure foe ducts <8 mm is achieved with success in more than 85% of cases. In many centres this is the method of choice for closure of the duct. Prostaglandin synthetase inhibitors, e.g. Aspirin and Indomethacin may be helpful. Infective endocarditis if develops should be treated.

PETENT DUCTUS ARTERIOSUS (PDA).

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