Patent ductus arteriosus

Question 1

What is the structure in utero which results in the ductus arteriosus?

Answer 1

Ligamentum arteriosum - normally connects the aorta to the pulmonary trunk and shunts blood away from the lungs, to the body since we don’t oxygenate our blood utero - mummy does it for us.

Question 2

Symptoms of patent ductus arteriosus

Answer 2

Machinery murmur
Left subclavicular thrill
Large volume, bounding collapsing pulse
Wide pulse pressure
Heaving apex beat

Question 3

What keeps the ligamentum arteriosum open?

Answer 3

Prostaglandins

Question 4

What can therefore be given to shut the patent ductus arteriosus?

Answer 4

Indomethacin or ibuprofen - stop prostaglandin synthesis

Question 5

RF for PDA

Answer 5

Preterm birth
Maternal RUBELLA infection in the first trimester
High altitude birth

Question 6

How might the management differ if there is another cardiac complication?

Answer 6

You might give prostaglandins to keep the shunt open if there is another congenital heart defect needing surgery.

Question 7

Complication of untreated PDA

Answer 7

Eisenmenger’s syndrome - aka when the blood starts going from right to left (cyanotic) instead of left to right as it was originally during birth (acyanotic).

Pulmonary hypertension

Question 7

What’s the name for the defect when the hole between the atria don’t close?

Answer 7

Patent foramen ovale (PFO).

Question 8

When should the PDA normally close?

Answer 8

Within first breaths? 24 hours?? Not sure. Ask.