Management Of PDA

persistant ductus arteriosus and it's management

1. Management of
Patent Dactus
Arteriosus
Presented by
Dr. Paul Shubhra Prakash

3. There are 3 options for
the treatment of PDA:
•Medical management
•Catheter based procedure
•Surgery

4. Aims of treatment:
• To treat or prevent Heart failure.
• To prevent infective endocarditis.
• To prevent development of
pulmonary vascular disease.

5. Medical management:
2.Conservative management:
a. Fluid restriction
b. Diuretic theraphy
c. Adequate calorie
d. Ventilator support
2. Drugs:
Indomethacin
Ibuprofen

6. Indications of drugs:
Prophylactic:
Dose: 0.1 mg/kg/dose 24 hourly for 6
days
Timing: usually within 1
st
24 hours of
life.
Indication: All infant <1250gm birth
weight who have respiratory
distress.

7. Therapeutic:
Timing: usually within 1
st
14 days of life.
Indications:
1. If there is any clinical sign of PDA
In preterm baby.
2.There are signs of overt failure or
congestive cardic failure.
3. Re-treatment after failure of the first
course indomethacin
4. Rcurrence of PDA after first course
of indomethacin

8. Dose of Indomethacin:
O.2mg/kg stat followed by

0.2 mg/kg/dose 12
hourly for 2 doses
>7days and birth
weight >1250gm
0.1 mg/kg/dose 12
hourly for 2 doses
<7days and birth
weight <1250gm

9. Adverse effect:
Renal dysfunction
Gastro-Intestinal bleeding
Thrombocytopenia
Periventricular Leucomalasia
Contra-indication:
Serum creatinine>1.8 mg/dl
Renal or Gastrointestinal bleeding
NEC
Sepsis

10. Dose of Ibuprofen:
Initial dose of 10mg/kg followed
at 24 hour intervals by two
doses of 5mg/kg.
As Ibuprofen has less Adverse
effect than Indomethacin, So
Ibuprofen is superior than
Indomethacin.

11. Catheter-based
Procedures:
Timing: usually done after
neonatal period

12. Indications:
• Small PDA with intra vascular coils.
• Moderate to Large PDA with a catheter
introduced sac into which several coils

are released or with an umbrella-like
device.

13. Device used in Catheter-Based
Procedures:

14. Catheter procedure:
•Sedation
•A small incision is
given in the inner thigh
•A long, thin, flexible,
hollow tube is inserted
through the femoral
vein
•Implantation of device
to PDA through tube.

15. Catheter based procedure:

16. Catheter based procedure:

17. Surgery:
Indications:
• A Premature or Full-term infant with
symptomatic heart failure from the PDA in
whom medical treatment has failed or in
whom there is a contraindication to the
use of drugs.
• A PDA isn’t successfully closed by a
Catheter-based Procedure.
• Surgery is planned for treatment of related
Congenital heart defects.

18. Timing: Usually after 6 months of
age.
Procedure:
Ligation and division of ductus via a

Thoracotomy.

19. Complications:
Bleeding
Pneumothorax
Chylothorax
Infection
Thoracic scoliosis

20. Surgical repair of PDA:

21. Surgery of PDA