Patent Ductus Arteriosus (PDA) скачать в хорошем качестве

Patent Ductus Arteriosus (PDA)

The incidence of ductal patency is inversely related to gestational age. There are many other important associations as well, including low birth weight, sepsis, congenital rubella, and birth at higher altitudes. Conversely, antenatal corticosteroid exposure actually decreases the risk of ductal patency. Spontaneous closure of a patent ductus arteriosus occurs in a large proportion of premature babies. Keep in mind that functional closure of the ductus arteriosus usually occurs by the fourth postnatal day, while anatomic closure usually occurs within the first few weeks of life. In term infants and older children, spontaneous closure of the duct usually does not occur. Manifestation of disease depends on the age of the patient and the degree of shunting. Full-term infants with a small duct may not develop any symptoms, whereas large ducts can result in pulmonary over-circulation and heart failure, typically beginning a few weeks following birth as the pulmonary vascular resistance drops. Parents may note irritability, diaphoresis, difficulty feeding, poor weight gain and recurrent respiratory infections, amongst other symptoms. In adult patients, a large uncorrected duct can result in severe pulmonary vascular injury and Eisenmenger syndrome. Large defects may manifest with a wide pulse pressure and a bounding pulse that is palpable in unusual locations (e.g., in the palms of the hands). The most characteristic finding on physical examination is a continuous machinery-like murmur at the upper left sternal border with or without a palpable thrill. In newborns, however, the murmur is usually confined to systole, irrespective of size of the ductus, because aortic pressure is not greater than pulmonary pressure during diastole. Echocardiography is the preferred test for establishing the diagnosis; it will allow for measurement of the size of the defect and the degree of shunting. As well, it can help rule out other co-existent congenital heart defects. ECG and chest x-ray may provide additional information, albeit with lower sensitivity and specificity than echocardiography. With small defects, both may be completely normal. With greater degrees of shunting, the chest x-ray may reveal a prominent main pulmonary artery, a prominent aortic knob, increased pulmonary vascular markings, and enlargement of the cardiac silhouette. With dilation of the left atrium, there can be splaying of the carinal angle. In regards to the ECG, older infants and children with a moderate degree of shunting may of electrocardiographic evidence of left atrial and ventricular enlargement. With a larger degree of shunting, there may be biventricular hypertrophy. Premature infants are at increased risk for several complications, including intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, pulmonary hemorrhage, necrotizing enterocolitis, and death. Unfortunately, ductal closure results in similar rates of morbidity and mortality as conservative therapy alone. Pharmacologic closure (e.g., with indomethacin) lacks efficacy in term infants and older patients. This subgroup of patients is usually treated with transcatheter occlusion, or surgical ligation in cases that are not amenable to a percutaneous approach. 📺 Subscribe To My Channel and Get More Great Quizzes and Tutorials    / @med4vl   #FOAMed #cardiology #MedEd Disclaimer: All the information provided by Medical Education for Visual Learners and associated videos are strictly for informational purposes only. It is not intended as a substitute for medical advice from your health care provider or physician. It should not be used to overrule the advice of a qualified healthcare provider, nor to provide advice for emergency medical treatment. If you think that you or someone that you know may be suffering from a medical condition, then please consult your physician or seek immediate medical attention.