Persistent Ductus Arteriosus (PDA)

General information:

  • The ductus arteriosus is a vascular connection between the pulmonary artery and the aortic arch (physiological situation in the fetal circulation).
  • The ductus should close within the first days after birth, closing the fetal right to left circulation effectively.
  • Hemodynamically effective shunt between the pulmonary artery and the aorta.

Symptoms:

  • High cardiac output failure.
  • Respiratory insufficiency, dependence on mechanical ventilation.
  • Elevated pusatility index.

Diagnostic workout:

  • Heart ultrasound (increased cardiac output; hypertrophic right ventricle).

Indication for conservative treatment/operation.

  • Hemodynamically effective shunt.
  • Exclude a shunt dependent heart malformation.
  • Exclude a persistent pulmonary hypertension (PPHT).
  • Thorbopenia (< 50000/mm3), recent bleeding, signs of renal insufficiency (urine volume < 1ml/kg BW/h)is a contraindication for conservative treatment (indomethacin, ibuprofen).

Treatment/Operation:

  • Conservative treatment with indomethcin or ibuprofen (first dosage: 10 mg/kg BW Ibuprofenlysin┬«, after 24h: 5 mg/kg BW Ibupofenlysin┬«, after 48h: 5 mg/kg BW Ibuprofenlysin┬«).
  • Operative closure trough a left lateral thoracotomy using a hemoclip.

Postoperative management:

  • A chest tube for lung expansion, control of the hemostasis and drainage of secretions.

Prognosis:

  • Good.
  • Increase of the mean arterial blood pressure.
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PAEDIATRIC SURGERY VIENNA
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