Patent ductus arteriosus (PDA) is a fetal vessel that
connects the main pulmonary trunk with the descending aorta distal to the
origin of the left subclavian artery. Most term infants have the PDA closed
by three weeks of age, while premature takes longer to close. In terms
infants, PDA can lead to death from congestive heart failure (tachypnea,
tachycardia, poor feeding, slow weight gain and recurrent pulmonary infections).
In premature, the PDA can lead to sepsis, renal failure, necrotizing enterocolitis,
metabolic acidosis and death. PDA murmur is systolic. Indications for closure
include congestive heart failure, bacterial endocarditis, failure
to close during the first year of life. In premature the PDA can be medically
closed with pharmacologic indomethacin therapy (prostaglandin inhibition).
If medical therapy fails surgical closure is needed. Surgical closure (division
is preferred for term and older children, while ligation is reserved for
premature) can be done through a left lateral thoracotomy, a medial sternotomy
or from inside the pulmonary artery. Other alternatives include percutaneous
catheter closure or thoracoscopic closure of the PDA. Some postoperative
complications include bleeding, damage to phrenic, vagus or recurrent laryngeal
nerve and chylothorax. In general prognosis is good.
References:
1- Little DC, Pratt TC, Blalock SE, Krauss DR, Cooney
DR, Custer MD: Patent ductus arteriosus in micropreemies and full-term
infants: the relative merits of surgical ligation versus indomethacin
treatment. J Pediatr Surg. 38(3):492-6, 2003
2- Wyllie J: Treatment of patent ductus arteriosus. Semin
Neonatol. 8(6):425-32, 2003
3- Van Overmeire B, Chemtob S: The pharmacologic closure
of the patent ductus arteriosus. Semin Fetal Neonatal Med. 10(2):177-84,
2005
4- Arora R: Transcatheter closure of patent ductus arteriosus.
Expert Rev Cardiovasc Ther. 3(5):865-74, 2005
5- Hermes-DeSantis ER, Clyman RI: Patent ductus arteriosus:
pathophysiology and management. J Perinatol. 26 Suppl 1:S14-8, 2006
6- Herrera C, Holberton J, Davis P: Prolonged versus
short course of indomethacin for the treatment of patent ductus arteriosus
in preterm infants. Cochrane Database Syst Rev. 18;(2):CD003480, 2007
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