test 5 Patent ductus arteriosis Flashcards
Patent Ductus Arteriosus
Fetal ductus arteriosus fails to close normally in an infant after birth
Allows antegrade flow from RV-Aorta prior to birth
Leads to abnormal blood flow between the aorta and pulmonary arteries (A-P shunt)
If PDA closes: all flow to aorta
If open: Ao-PA shunt (L-R shunt)
Extensive aortic runoff with low aortic diastolic pressure will cause organ hypoperfusion
Affects girls more often than boys
Common in premature infants and those with neonatal respiratory distress syndrome
Often seen in Down syndrome
Common in babies with other congenital defects
Patent Ductus Arteriosus pathophys
If a large PDA is not corrected
Increased Qp:Qs
Pulmonary hypertension
Shunt reversal can occur resulting in cyanosis
Patent Ductus Arteriosus Surgical Correction
The goal, if the rest of the circulation is normal, is to close the PDA
Sometimes the PDA will close on its own
Premature babies have a high rate of closure within 2 years
Full term infants, spontaneous closure is rare after the first few weeks
Cath lab transcatheter device closure
Small metal coil with mesh in between coils
Placed from pulmonary side
OR surgical correction
Ligation
Division
Not a pump case when it is the only defect
Done in NICU/ICU at bedside
Keeping the patent ductus arteriosis open
Exogenous prostaglandins can be used to extend the patency of the ductus in neonates where bypassing the defective vessel or continued mixing of blood is needed to provide adequate systemic circulation (HLHS)
Prostaglandin E1 (PGE1) is the drug of choice
Generic pharmaceutical name: alprostadil
PGE1
Routinely used in infants with ductus-dependent cardiac lesions
Continued until atrial septostomy or corrective surgery
In most infants, the ductus will reopen within 30 minutes to 2 hours after starting PGE1
