diskusi kasus patent duktus arteriosus .pptx

pda

1. PDA

2. Discussion

3. EPIDEMIOLOGY Data among term infants suggest that PDAs are observed in ≈1 in 2000 births, accounting for 5% to 10% of all congenital heart disease. Longitudinal cohort studies suggest that the incidence of “silent” PDA, those cases discovered by cardiac imaging in the absence of clinical manifestations, approach 1 in 20 births. Backes CH, Hill KD, Shelton EL, et al. Patent Ductus Arteriosus: A Contemporary Perspective for the Pediatric and Adult Cardiac Care Provider. J Am Heart Assoc. 2022;11:e025784. DOI: 10.1161/JAHA.122.025784

4. PATHOPHYSIOLOGY L ong-standing left-to-right shunting higher pressures greater blood flows arteriolar medial hypertrophy intimal proliferation and fibrosis obliteration of pulmonary arterioles and capillaries increased pulmonary vascular resistance P ulmonary A rterial hypertension (PAH). PVR > systemic vascular resistance D uctal shunting reverses (Right to left) Eisenmenger syndrome progressive morphological changes in the pulmonary vasculature Backes CH, Hill KD, Shelton EL, et al. Patent Ductus Arteriosus: A Contemporary Perspective for the Pediatric and Adult Cardiac Care Provider. J Am Heart Assoc. 2022;11:e025784. DOI: 10.1161/JAHA.122.025784

5. Clubbing of toenails and spared (or mild) clubbing in the fingers is pathognomonic for Eisenmenger syndrome in the setting of a PDA. P atients may develop right ventricular systolic failure, the most common cause of death among patients with Eisenmenger syndrome. PATHOPHYSIOLOGY Backes CH, Hill KD, Shelton EL, et al. Patent Ductus Arteriosus: A Contemporary Perspective for the Pediatric and Adult Cardiac Care Provider. J Am Heart Assoc. 2022;11:e025784. DOI: 10.1161/JAHA.122.025784

6. Management of PDA With Associated PAH short-term pulmonary vasodilator testing ( eg , decrease of ≥20% in mean pulmonary artery pressure after administration of 100% oxygen and/or 80 parts per million of inhaled NO) pulmonary artery/systolic blood pressure ratios (cardiac index) <0.8 during test occlusion pulmonary vascular resistance index, >6 Wood units m2, poor candidates for intervention Backes CH, Hill KD, Shelton EL, et al. Patent Ductus Arteriosus: A Contemporary Perspective for the Pediatric and Adult Cardiac Care Provider. J Am Heart Assoc. 2022;11:e025784. DOI: 10.1161/JAHA.122.025784

7. Management of HSPDA According to 2011 guidelines from the American Heart Association on cardiac catheterization in pediatric heart disease, based on consensus expert opinion, transcatheter PDA occlusion is indicated in older patients for the treatment of an HSPDA with “ left-to-right shunt that results in any of the following: congestive heart failure, failure to thrive, pulmonary overcirculation , or an enlarged left atrium or left ventricle, provided the anatomy and patient size are suitable ” (class I recommendation, level of evidence B) Feltes TF, Bacha E, Beekman RH III, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation . 2011;123:2607–2652. doi : 10.1161/CIR.0b013e31821b1f10 Backes CH, Hill KD, Shelton EL, et al. Patent Ductus Arteriosus: A Contemporary Perspective for the Pediatric and Adult Cardiac Care Provider. J Am Heart Assoc. 2022;11:e025784. DOI: 10.1161/JAHA.122.025784

8. Baumgartner H,Backer JD,Narayan SVB, et al. 2020 ESC Guidelines for themanagement of adult congenital heart disease. European Heart Journal (2021) 42, 563-645. doi:10.1093/ eurheartj /ehaa554

9. PDA banding ??? The PDA banding was performed urgently as a rescue measure in order to restore systemic flow while still maintaining some duct-dependent pulmonary blood flow. The strategy of PDA banding for PHTN creates a ‘window ’ of opportunity for eventual PDA closure. Yoneyama F, Imamura M, Bansal M, et al. Patent ductus arteriosus banding for pulmonary hypertension. Published by Elsevier B.V. 2023. Progress in Pediatric Cardiology 70 (2023) 101655. doi.org/10.1016/j.ppedcard.2023.101655 Bautista- Rodriguez C, Rodriguez -Fanjul J, Moreno Hernando J, Mayol J, Caffarena - Calvar JM. Patent ductus arteriosus banding for circular shunting after pulmonary valvuloplasty. World J Pediatr Congenit Heart Surg 2017;8:643–5.