Patent ductus arteriosus(PDA): Symptoms, Diagnosis & Complications
The patent ductus arteriosus is a case in which the obstructed pulmonary artery keeps open immediately after birth, and pulmonary vascular resistance is decreased and aortic blood flow enters the pulmonary artery. Frequency is two times higher in girls than in boys and is well accompanied by rubella infection in early pregnancy. Patients with patent ductus arteriosus tend to have a high incidence in preterm infants as in this case, 10% of congenital heart disease is accompanied by patent ductus arteriosus. Symptoms are mild, almost asymptomatic, and heart murmurs may be detected with a stethoscope. If the patency of the ductus arteriosus is large, it may be accompanied by heart failure and growth retardation from infancy. Typical clinical findings include wide pulse pressure, leaping veins, and sustained mechanical heart murmurs at the left sternal level. In the case of neonatal or pulmonary arterial hypertension, only systolic noise may be heard.
In the chest X-ray, the heart size is determined by the amount of left and right shorts. The left atrium, left ventricle, ascending aorta and pulmonary artery are enlarged, and pulmonary blood vessels increase. Electrocardiogram shows left atrial and left ventricular hypertrophy in the presence of a large number of shorts, and bipolar patients in the presence of pulmonary hypertension. Echocardiography may reveal left atrial and left ventricular dilatation as well as Doppler findings. The cardiopulmonary bypass allows the right and left shorts of the pulmonary artery to pass through the ductus between the pulmonary artery and descending aorta. The ascending aorta can be seen with a patent ductus arteriosus.
All ducts that hear a murmur are subject to treatment regardless of size or symptom. Surgery can be performed irrespective of age or weight because of the low risk. Recently, cardiac catheterization using a coil or a closure device has been performed except premature infants and large ductal vessels in early infancy. There is no symptom in the case of a small duct, but there is a risk of arterial meningitis if heart murmur is heard. If the patency of the patent duct is large, heart failure may be seen early and delayed treatment may lead to Eisenmenger syndrome.
In premature infants, obstruction of the ductus arteriosus is delayed, especially when neonatal respiratory distress is accompanied by hypoxemia, acidosis, increased pulmonary blood pressure due to vasoconstriction, hypotension, and pulmonary immaturity. Patients with persistent apnea, excessive heartbeat, wide pulse pressure, leaping pulse, systolic or persistent heart murmur, arterial PCO2 elevation, increased oxygen dependence, and hepatomegaly can be seen to be open even if the neonatal respiratory distress is improved. There is also a case of general therapy such as diuretic and water restriction. However, if closure is delayed or symptoms do not improve, indomethacin may be given 3 times at 12 to 24 hours intervals and repeated administration may be necessary if necessary. However, thrombocytopenia, bleeding tendency, oliguria. Necrotizing enteritis, long bowel movement, and serum creatine elevation are contraindications. Ibuprofen is also an effective drug for the closure of the ductus arteriosus. If heart failure and respiratory depression persist without sustained drug closure, surgical treatment is required.
In the chest X-ray, the heart size is determined by the amount of left and right shorts. The left atrium, left ventricle, ascending aorta and pulmonary artery are enlarged, and pulmonary blood vessels increase. Electrocardiogram shows left atrial and left ventricular hypertrophy in the presence of a large number of shorts, and bipolar patients in the presence of pulmonary hypertension. Echocardiography may reveal left atrial and left ventricular dilatation as well as Doppler findings. The cardiopulmonary bypass allows the right and left shorts of the pulmonary artery to pass through the ductus between the pulmonary artery and descending aorta. The ascending aorta can be seen with a patent ductus arteriosus.
All ducts that hear a murmur are subject to treatment regardless of size or symptom. Surgery can be performed irrespective of age or weight because of the low risk. Recently, cardiac catheterization using a coil or a closure device has been performed except premature infants and large ductal vessels in early infancy. There is no symptom in the case of a small duct, but there is a risk of arterial meningitis if heart murmur is heard. If the patency of the patent duct is large, heart failure may be seen early and delayed treatment may lead to Eisenmenger syndrome.
In premature infants, obstruction of the ductus arteriosus is delayed, especially when neonatal respiratory distress is accompanied by hypoxemia, acidosis, increased pulmonary blood pressure due to vasoconstriction, hypotension, and pulmonary immaturity. Patients with persistent apnea, excessive heartbeat, wide pulse pressure, leaping pulse, systolic or persistent heart murmur, arterial PCO2 elevation, increased oxygen dependence, and hepatomegaly can be seen to be open even if the neonatal respiratory distress is improved. There is also a case of general therapy such as diuretic and water restriction. However, if closure is delayed or symptoms do not improve, indomethacin may be given 3 times at 12 to 24 hours intervals and repeated administration may be necessary if necessary. However, thrombocytopenia, bleeding tendency, oliguria. Necrotizing enteritis, long bowel movement, and serum creatine elevation are contraindications. Ibuprofen is also an effective drug for the closure of the ductus arteriosus. If heart failure and respiratory depression persist without sustained drug closure, surgical treatment is required.
