The patent ductus arteriosus (PDA) is a persistent fetal connection (ductus arteriosus) between the aorta and the pulmonary artery after birth, resulting in a left-right shunt. Symptoms may include failure to thrive, eating difficulties, tachycardia, and tachypnea. A persistent noise in the upper left sternal border is typical. The diagnosis is made by echocardiography. A therapeutic trial with indomethacin, with or without fluid restriction can be made in preterm infants with a big shunt, but not for newborns or older children with PDA. When the compound persisted, a correction must either surgically or performed by catheter.

PDA accounts for 5-10% of congenital heart disease, with a male / female incidence of 1: 3. The PDA is in preterm infants (is about 45% with a birth weight <1750 g and at 80% with a birth weight <1200 g before) to find common. A large PDA causes a heart failure in 15% of premature infants weighing <1750 g and at 40-50% with a weight <1500 g.

The patent ductus arteriosus (PDA) is a persistent fetal connection (ductus arteriosus) between the aorta and the pulmonary artery after birth, resulting in a left-right shunt. Symptoms may include failure to thrive, eating difficulties, tachycardia, and tachypnea. A persistent noise in the upper left sternal border is typical. The diagnosis is made by echocardiography. A therapeutic trial with indomethacin, with or without fluid restriction can be made in preterm infants with a big shunt, but not for newborns or older children with PDA. When the compound persisted, a correction must either surgically or performed by catheter. PDA accounts for 5-10% of congenital heart disease, with a male / female incidence of 1: 3. The PDA is in preterm infants (is about 45% with a birth weight <1750 g and at 80% with a birth weight <1200 g before) to find common. A large PDA causes a heart failure in 15% of premature infants weighing <1750 g and at 40-50% with a weight <1500 g. Pathophysiology The ductus arteriosus is a normal connection between the pulmonary artery and the aorta, which is necessary for the fetal circulation. At birth, an increase in the partial pressure of oxygen (PaO2) and a drop of prostaglandins cause a closure of the ductus arteriosus within the first 10-15 hours of life. If this normal process does not take place, the result is an open, patent ductus arteriosus (Patent ductus arteriosus). Patent ductus arteriosus The pulmonary blood flow, the LA and LV volumes and the rising AO volume is increased. AO = aorta, LA = left atrium; LV = Left ventricle; PA = pulmonary artery. The physiological effects depend on the diameter of the ductus arteriosus. A small patent ductus arteriosus rarely causes symptoms. A tall, short and patent ductus causes a large left-right shunt. Over time, these shunts can a left heart enlargement, hypertension of the pulmonary arteries and an increased, pulmonary vascular resistance and consequently lead to Eisenmenger syndrome (Eisenmenger's syndrome). Symptoms and signs Clinical findings depend on the size of the PDA and the age from the newborn. Infants and young children with a small PDA are usually asymptomatic; Infants with a large PDA show signs of heart failure (for. Example, failure to thrive, nutritional problems, tachypnea, dyspnea during feeding and tachycardia). Premature babies may dyspnea, apnea, impaired mechanical ventilation or other serious complications show (z. B. necrotising enterocolitis). The signs of heart failure can be seen in premature infants and more pronounced than in term infants. A big shunt in the ductus arteriosus in a premature infant is often a key factor in the severity of lung disease in preterm infants. Most children with a small patent ductus arteriosus have normal heart sounds and pulses. Can best hear a continuous murmur of grade 1-3 / 6 at the upper left sternal. The murmur extends from the systole over the second heart sound (S2) to the diastole and usually has a different pitch at systole and diastole. Term infants with a large patent ductus arteriosus have a pulsus celer et old with a large pulse amplitude. A continuous cardiac murmur of grade 1-4 / 6 is characteristic. If the noise is loud, it has a machine-like quality. Apical diastolic rumble (due to strong blood flow across the mitral valve) or a gallop rhythm is heard when there is a large left-right shunt or heart failure develops. Premature infants with a big shunt have pulsating pulse and a heaving apex beat. A heart noise can be heard over the pulmonary area, the sound is continuous, systolic or diastolic component with a short purely systolic, depending on pulmonary artery pressure. Some children have no audible heart sounds. Diagnostic chest X-ray and ECG echocardiogram Diagnosis is suspected based on clinical examination, supported by chest x-ray and EKG and confirmed by a two-dimensional Farbechokardiographie with Doppler examination. The chest x-ray and ECG are normal in a small open ductus arteriosus. The ECG you may see a left ventricular hypertrophy. With large shunts the chest x-ray a prominent left atrium, left ventricle, one ascending aorta and left ventricular hypertrophy can show. A cardiac catheterization is not usually necessary. Treatment prostaglandin therapy (. Eg indomethacin, ibuprofen) Sometimes transcatheter Okklusionsinstrumente or surgical intervention in premature infants with impaired respiratory condition, the open ductus arteriosus with a prostaglandin synthesis inhibitors (eg, indomethacin see table. Notes on dosage of indomethacin (mg / kg) * for cans]) are closed. Three doses of indomethacin are based on the output in the urine i.v. given every 12 to 24 hours; the cans are retained if the output in the urine is <0.6 ml / kg / h. An alternative is ibuprofen 10 mg / kg p.o., followed by 2 doses of 5 mg / kg in 24-h intervals). Hydration can facilitate ductal closure. In the past, PDA was surgically ligated if this treatment was not successful. However, recent data show improved long-term outcomes after surgery, but experts assess moments if there are subgroups of patients who might be an operation advantage. In premature infants without Beeinschränkung breathing a PDA is not usually treated. Notes on dosage of indomethacin (mg / kg) * Age at first dose 1st dose 2nd dose 3rd dose <48 h 0.2 0.1 0.1 0.2 0.2 0.2 2-7 days > 7 days 0.2 0.25 0.25 * Dose intervals are based on the output in the urine (s. Text). In term infants indomethacin is ineffective. The transcatheter occlusion has become the treatment of choice in children> 1 year. A variety of catheter special equipment for occlusion are available (z. B. Coils [spirals] AMPLATZER® channel occluder). In infants <1 year or in infants who have a certain anatomical variety of the duct, the surgical ligation of the Trankathter occlusion may be preferred. In a PDA with a shunt that is large enough to cause symptoms of heart failure or pulmonary hypertension, the occlusion after medical stabilization should occur. For a patent ductus arteriosus without heart failure or pulmonary hypertension occlusion can be done electively after the first year of life. The results after a closure of patent ductus arteriosus are excellent. Cierre del conducto arterioso persistent (CAP) con espirales var model = {thumbnailUrl: '/-/media/manual/professional/images/patent_ductus_arteriosus_coil_closure_high_blausen_de.jpg?la=de&thn=0&mw=350' imageUrl: '/ - / media / manual /professional/images/patent_ductus_arteriosus_coil_closure_high_blausen_de.jpg?la=de&thn=0 ', title:' Cierre del conducto arterioso persistent (CAP) con espirales' description: '' credits' ', hideCredits: false, hideTitle: false, hideFigure : false, hideDescription: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( 'image-element-panel.'). ko.applyBindings (model, panel.get (0)); Cierre del conducto arterioso persistent (CAP) con dispositivos var model = {thumbnailUrl: '/-/media/manual/professional/images/patent_ductus_arteriosus_device_closure_high_blausen_de.jpg?la=de&thn=0&mw=350' imageUrl: '/ - / media / manual /professional/images/patent_ductus_arteriosus_device_closure_high_blausen_de.jpg?la=de&thn=0 ', title:' Cierre del conducto arterioso persistent (CAP) con dispositivos' description: '' credits' ', hideCredits: false, hideTitle: false, hideFigure : false, hideDescription: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( 'image-element-panel.'). ko.applyBindings (model, panel.get (0)); Endocarditis prophylaxis is before the operation is not necessary, but probably in the first 6 months after surgery or when a residual defect in addition to the treated site is present. Key points The patent ductus arteriosus (PDA) is a persistence after the birth of a normal fetal connection (ductus arteriosus) between the aorta and the pulmonary artery, which leads to a left-right shunt. The manifestations depend on the size of the PDA and the degree of prematurity, but a continuous noise characteristic, and if it is loud, it is reminiscent of a "machine sound." Premature babies may shortness of breath or other serious complications show (z. B. necrotising enterocolitis). Over time, these shunts can cause left ventricular enlargement, hypertension of the pulmonary arteries and an increased, pulmonary vascular resistance and consequently lead to Eisenmenger syndrome. Preterm is administered a prostaglandin inhibitor (e.g., indomethacin.) To close the PDA; it could not be shown that surgical closure improves prognosis. Prostaglandin inhibitors are ineffective in term infants usually, but delivered through a catheter occlusion devices or surgery usually help.

Health Life Media Team

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