Ductus
arteriosus connects pulmonary artery at its bifurcation to the descending aorta
immediately distal to the origin of left subclavian artery. In foetal life it
(PDA) diverts the blood from pulmonary artery to aorta. If it (PDA) persists
blood from aorta passes to pulmonary artery. In long term the shunt is reversed
in presence of sever pulmonary hypertension which is called Eisenmenger’s
syndrome.
Clinical
features:
Symptoms:
Usually absent for
many years. Symptoms arise when Eisenmenger’s syndrome develops, e.g. Dyspnoea,
fatigue and features of cardiac failure.
Signs:
1.
General:
Growth retardation, central cyanosis.
2.
CVS:
a)
Pulse:
Large volume, collapsing.
b)
BP:
Low diastolic pressure, increased pulse pressure.
c)
LVH:
Apex beat shifted downwards and outwards.
d)
Thrill
over pulmonary area.
e)
Murmru:
·
Gibson’s
murmur.
·
Apical
mid-diastolic murmur.
Investigations:
1.
Chest
X-ray:
·
Enlargement
of heart.
·
Prominent
pulmonary artery.
·
Plethoric
lung fields.
2.
ECG
finding:
·
Usually
normal.
·
LVH
may present.
3.
Echo:
·
RA
and RV dilatation.
·
Demonstration
of duct in cross sectional echo.
Management:
1.
Premature
infants with PDA: Medical treatment with indomethacin or ibuprofen (used in
first week of life to induce closure).
2.
Surgical:
Closure of patent ductus at cardiac catheterization with an implantable
occlusive device.
3.
Older
children and adults with small shunt: Medical management, prophylaxis against
infective endocarditis.
Reference:
1.
Davidson’s
Principles and Practice of Medicine, 21st edition.
2.
Wikipedia
the free encyclopedia.
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