What are prostaglandins a product of?
arachidonic acid
What could happen if a large PDA is left untreated?
pulmonary venous occlusive disease (***Eisenmenger’s syndrome- irreversible pulmonary hypertension) increased risk of subacute bacterial endocarditis
How does the ductus arteriosus close?
- fewer elastic fibers and more SM in the ductus 2. increased PaO2 after birth causes contraction of SM 3. removal of placenta removes prostaglandins that kept it open en utero
DX? Respiratory effects (Difficulty weaning off the ventilator, Pulmonary edema/hemorrhage) CHF Feeding intolerance, bowel ischemia, necrotizing enterocolitis Renal insufficiency Intraventricular hemorrhage or stroke Death
PDA
What is a shunt?
a connection between two chambers/vessels
How will a small PDA present?
usually baby will be asymptomatic
What are the physical exam findings in a large PDA with L to R shunting?
wide pulse pressure bounding pulses (palpable palmar pulses) increased work of breathing hyperactive precordium murmur
In whom is the incidence of PDA increased?
premees (70% of all babies born at
What is the classic murmur in PDA?
Continuous or machinery-sounding murmur along the left upper sternal border possible diastolic rumble
How old is the baby when a patent ductus arteriosus is considered persistent?
1 year
Usually a PDA is a _____ (direction) shunt.
L to R
What does PDA stand for?
persistent ductus arteriosus
What is the incidence of PDA?
5-12% of all congenital heart defects
DX? wide pulse pressure bounding pulses (palpable palmar pulses) increased work of breathing hyperactive precordium murmur
signs of PDA
____ is the most potent agent for maintaining ductal patency.
PGE2
In whom is the incidence of PDA increased?
premees (70% of all babies born at
How does a moderate/large PDA present?
Respiratory effects (Difficulty weaning off the ventilator, Pulmonary edema/hemorrhage) CHF Feeding intolerance, bowel ischemia, necrotizing enterocolitis Renal insufficiency Intraventricular hemorrhage or stroke Death
How does a moderate/large PDA present?
Respiratory effects (Difficulty weaning off the ventilator, Pulmonary edema/hemorrhage) CHF Feeding intolerance, bowel ischemia, necrotizing enterocolitis Renal insufficiency Intraventricular hemorrhage or stroke Death
DX? Continuous or machinery-sounding murmur along the left upper sternal border possible diastolic rumble
PDA
When is a the PDA a R to L shunt?
in premees, babies with lung disease, or babies born at high altitude (all causes of elevated pulm vascular resistance)
DX? Respiratory effects (Difficulty weaning off the ventilator, Pulmonary edema/hemorrhage) CHF Feeding intolerance, bowel ischemia, necrotizing enterocolitis Renal insufficiency Intraventricular hemorrhage or stroke Death
PDA
What does PDA stand for?
patent ductus arteriosus
What is a connection between two chambers/vessels?
a shunt
How is the ductus arteriosus kept open when needed?
IV PGE2
How is PDA treated?
COX inhibitors (IV indomethacin) surgical ligation or percutaneous occlusion
What is a shunt?
a connection between two chambers/vessels
Where does the ductus arteriosus derive from?
left 6th aortic arch
How does a moderate/large PDA present?
respiratory effects (difficulty weaning off ventilator, pulmonary edema/hemorrhage) CHF feeding intolerance, bowel ischemia, necrotizing enterocolitis renal insuff intraventricular hemorrhage or stroke death
Older infant or young child with a ______ may present with a hoarse cry, history of pneumonias, failure to thrive, increased work of breathing and diaphoresis with activity/feeding.
large PDA
When does closure of the ductus arteriosus normally occur?
functional closure at 10-15 hrs after birth (delayed at altitude, tho) anatomic closure by 2-3 week of life
