Patent Ductus Arteriousus

Question 1

List congenital symptoms associated with PDA

Answer 1

Increased risk of ventiliation
pulmonary hemorrhage
Bronchopulmonary dysplasia

diastolic steal could be associated with 
renal hypoperfusion
intestinal ischemia
necrotizing enercolotis (NEC) 
intraventricular hemorrhage

Question 2

What is medical treatment of PDA

Answer 2

In premature neonates in can be prophylactic or symptomatic

COX inhibitor within first 24 hours. Indomethacin and ibuprofen are equally effective at producing closure. Closure rates are 60 to 80% with a single dose.

Ineffective in term neonates because of lack of prostaglandin responsive contractile smooth muscle in their ductal tissue.

Question 3

Surgical therapy in premature infants

Answer 3

reserved for failed medical therapy in symptomatic patients and for those with contraindications for COX inhibitor therapy. (NEC/renal dysnfunction/IVH)

Question 4

Surgery for Full-Term infants, children, and Adult

Answer 4

Surgical or transcatheter closure is the mainstay of therapy.

Indicated for both symptomatic and asymptomatic patients to reduce the risk of endocarditis and pulmonary hypertension.

Asymptomatic may undergo elective closure 1 to 2 years of age–to facilitate VATS

Can be done via thoracotomy, median sternotomy, device, or VATS

Question 5

Complications of a PDA ligation

Answer 5

Mortality < 1% 
left recurrent laryngeal nerve injury
bleeding
postoperative chylothorax
development of coarctation

Question 6

What is surgical approach for PDA

Answer 6

Posteriolateral thoractomy (3rd or 4th intercostal space)
Device closure
Video-assisted thoracoscopic
*(not for adulats)
Remember to put an adult on CPB
place a fogarty cath in the PDA and close it from the inside
snare both PA
you could place a vent into the PA and drain…and then repair from the inside or outside

Question 7

What is prevalence, pathophyioslogy and natural history.

Answer 7

20 to 80% of neonates and varies inversely with gestational age and birth weight

Genetic implications of prostaglandin receptors and regulators of smooth muscle contraction

In utero-DA shunts-right to left because of high resistance of pulmonary circulation. Birth–decline in PVR–ductal closure in a few hours–mediated by loss of placental source of prostaglandins, increased arterial oxygen tension.

PDA of term infant unlikely to respond to NSAID but pre-term will.

Spontaneous closure 4 days (90 to 95%) and 80 to 90% of premature infants at 30 to 37 weeks