PDA Flashcards
PDA Presentation during Adulthood
After closure during childhood
- Unremarkable findings require no follow-up
- Residual shunt, PAH, LVSD (Rare)
PDA Natural History
small PDA: Normal LV, normal PASP, asymptomatic
Moderate PDA with LV volume overload predominance: Enlarged LV with normal or reduced LVSD
Moderate PDA with PAH predominance: RV pressure overload (RHF)
PDA - Eisenmenger: Differential cyanosis
What is differential cyanosis?
Appearance of cyanosis in both lower extremities with a pink right upper extremity.
PDA Physical Examination
Continuous systolic-diastolic murmur systolic murmur (PAH) No murmur (very small - silent duct or Eisenmenger) CHF (Left/right) Differential Cyanosis
DD of continuous systolic-diastolic mumur
- Aorto-pulmonary window
- Aorto-pulmonary collaterals
- Coronary fistula
- Ruptured Sinus valsalva aneurysm
PDA ECG
Normals
Signs of LV/LA –> RV overload
Which patients should have their PDA closed?
- Signs of lv volume overload
- PAH but PAP
What is the preferred method of PDA closure?
Device closure if technically suitable
Which patients should have PDA closure considered?
- pAH and PAP >⅔ of systemic pressure of PVR >⅔ SVR. but still net L-R shunt (Qp:Qs >1.5) or when testing (preferably with NO) or Tx demonstrates pulmonary vascular reactivity
- Small PDA with continuous murmur (normal LV and PAP)
In which patients should PDA closure be avoided?
- Silent duct
- PDA Eisenmenger or patients with severe PAH and exercise-induced lower limb desaturation
How frequently should PDA patients with LV dysfunction and elevated PASP be followed up?
1-3 year intervals
How regularly should patients w/o residual shunt, normal LV and PAP be followed-up?
No regular f/u after 6/12 post-intervention
Exercise/sport advice in patients with PDA
Only limited in patients with pah
Pregnancy advice in PDA
Elevated risk only in pAH
Endocarditis prophylaxis in PDA
Only in case of implants with residual shunt (and during the first 6/12 after intervention)
