Patent ductus arteriosus [PDA], shane stanley.pptx

Patent ductus arteriosus [PDA], shane stanley.pptx

1. Patent ductus arteriosus [PDA ] Shane Stanley

2. Introduction Patent ductus arteriosus (PDA) is a congenital heart defect where the ductus arteriosus, a fetal blood vessel that connects the pulmonary artery to the aorta, fails to close after birth. This condition can lead to various cardiovascular complications depending on the size of the PDA and the patient's overall cardiovascular health. Definition and Normal Closure: PDA is a vascular structure that connects the proximal descending aorta to the pulmonary artery, which normally closes spontaneously after birth.

3. Anatomy-Pathology

4. Clinical Significance and Hemodynamic Impact PDA can lead to significant neonatal morbidities such as intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, and even death, particularly in preterm infants. The physiological impact of PDA largely depends on its size and the underlying cardiovascular status of the patient, with larger PDAs causing more severe complications. The physiological impact of PDA depends on its size and the underlying cardiovascular status. A significant left-to-right shunt can lead to pulmonary over-circulation and systemic hypoperfusion( arterial oxygen unsaturation) , worsening cardiopulmonary status and increasing the risk of complication

5. Impact on Preterm Infants: In preterm infants, PDA can exacerbate conditions like respiratory distress syndrome and lead to prolonged ventilation, increasing the risk of bronchopulmonary dysplasia and other complications. The timing and method of intervention (prophylactic, presymptomatic, or symptomatic) remain areas of ongoing research If the shunt is moderate to large it will result in left heart volume overload overload and in some cases pulmonary hypertension and Eisenmenger’s syndrome. However, The characteristic clinical signs are a bounding pulse and continuous ‘machinery murmur’ however as pulmonary hypertension develops in a large PDA the murmur becomes softer.

6. Association with Morbidities : PDA is linked to several neonatal morbidities, including bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP). The presence of PDA is associated with increased mortality and the need for respiratory support.

7. Diagnosis PDA can be diagnosed through noninvasive imaging techniques such as echocardiography, which is critical for detecting silent or asymptomatic cases With a large shunt, the aorta and pulmonary arterial system may be prominent on chest X-ray. The ECG may demonstrate left atrial abnormality and left ventricular hypertrophy. The development of Eisenmenger reaction will produce right ventricular hypertrophy.

8. Management and Treatment : Treatment options for PDA include fluid restriction, diuretics, pharmacologic interventions (e.g., indomethacin or ibuprofen lysine) surgical ligation. Transcatheter techniques are preferred for children and adults. The choice of treatment may depend on the size of the PDA and the patient's age and overall health status.

9. Conservative Management : Conservative management strategies, which avoid immediate closure of PDA, are gaining interest due to the lack of clear evidence supporting the benefits of early intervention. Conservative approaches aim to mitigate the impact of shunt volume without achieving ductal closure, focusing on supportive care Long-term Outcomes : The long-term neurodevelopmental outcomes of infants with PDA are influenced by the severity of the initial condition and the treatments used. Surgical ligation has been associated with chronic lung disease and neurodevelopmental impairment, although these associations may be confounded by the severity of the infants' conditions.

10. Genetic and Developmental Factors : Genetic predisposition and developmental factors play a significant role in the persistence of PDA, especially in preterm infants. Variability in drug response and toxicity is also influenced by genetic factors

11. Conclusion Patent ductus arteriosus (PDA) is a common congenital heart defect that can lead to serious cardiovascular and pulmonary complications if not treated. Understanding the pathophysiology, clinical implications, and management strategies is crucial for effective treatment and improved patient outcomes.