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PERSISTANT DUCTUS

ARTERIOSUS

Lourdes Asiain M.D.

October 2004

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PERSISTENT DUCTUS ARTERIOSUS

Definition: Ductus arteriosus is a vessel that connects the pulmonaryartery and aorta.

Failure of closure and continued patency of fetal channel

is termed PERSISENT DUTUS !RTERI"SUS #PD!$

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ISTOLO!"

ircumferential

Increased mucoid

Su%stance in

Intima

S#oot$

Musc%e

E&trace%

#atri&

ylindrical layers

Spiral in opposin&Directons

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PDA

In the fetus' the ductus diverts %lood flo( from the

pulmonary circulation #hi&h resistance$ to the

descendin& aorta.

!n Increase in Pa") constricts the ductus. "ther

factors' such as the release of vasoactive

su%stances' contri%ute to the closure

*alance %et(een constrictin&+rela,in& su%stances

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Factors

Influencin& closure

of duct

ontractile!pparatus

Increased Pa ",y&en

!%sent

"r reduced#asphy,ia' hi&h

!ltitude$

Rela,ant influences Prosta&landins

Unresponsive"r deficient

#prematurity'

-enetic$

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PDA

In full term healthy ne(%orns' functional closure

occurs in /0 %y )1 hrs of a&e' in 2/0 %y 13 hrs.

The effects of o,y&en and prosta&landins vary at

different &estational a&es. ",y&en has less of a constrictin& effect (ith decreasin&

&estational a&e

Indomethacin constricts the immature ductus more than the

term ductus

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PDA

Factors assoc (ith increasedincidence

Prematurity RDS

Fluid overload !sphy,ia

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PDA' (actors t$at increase

incidence

Pre#aturit): Inversely related to &estational a&e

Found in appro,. 10 of infants 456/&m

3/0 of infants 45///&m

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PDA' (actors t$at increase

incidence

RDS

orrelated (ith severity of RDS.

!fter surfactant treatment increased ris7 of

clinically symptomatic PD!

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PDA

Factors associated (ith decreased incidence

!ntenatal steroid administration

IU-R

Prolon&ed rupture of mem%ranes

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C%inica% Si*ns

The clinical features assoc (ith 8 to R shunt

depend on the ma&nitude of shunt and the

a%ility to handle e,tra volume.

Shunt: ma&nitude and direction related to

vessel diameter and pressure &radient

%et(een ! and P!.

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PDA' C%inica% Si*ns

9urmur

yperactive precordium

*oundin& peripheral pulses Increase in pulse pressure

ypotension

Respiratory deterioration

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PDA' Mana*e#ent

;entilatory support

Fluid restriction

9aintain hematocritNon sur&ical: Indomethacin #P-E5 inhi%$

I%uprofen

TranscatheterSur&ical: 8i&ation

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PDA' Indo#et$acin

Prophylactic:/.5m&+7&+dose < )1

hrs for = days

Symptomatic:5st /.)m&+7& /.)m&+>&

)nd /.5m&+7& /.)m&+7&

?rd /.5m&+7& /.)m&+7&

Dose

45)/&m

4 6 days

@5)/&m

@ 6 days

Prolon&ed: 1th'thand =thdose at )1 hr intervals

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PDA' Indo#et$acin

omplications:

Renal: decreased -FR

-I *leedin&Platelet dysfunction

ontraindicated if reatinine @5.6m&' if patientis septic or if NE present

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Co#+%ications o, PDA

F

Pulmonary hypertension!neurysm of duct #rare$

Throm%oem%olism #rare$

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Conc%usions

ommon in preterm infants

Initial presentation usually D"8 5A1'ardiopulmonary si&ns: murmur' %oundin&pulses' hyperactive precordium' respdeterioration.

9ana&ement: sur&ical

non sur&ical

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Re,erences

NeoFa, )//1.56thedition.Thomas E. Boun&'

9D and *arry 9an&um .

Neonatolo&y thedition.)//1. Tricia 8acy

-omella.

!veryCs diseases of the Ne(%orn. Taeusch et

*allard.