Management of Patent Dactus

ArteriosusPresented by

Dr. Paul Shubhra Prakash

There are 3 options for the treatment of PDA:

• Medical management

• Catheter based procedure

• Surgery

Aims of treatment:• To treat or prevent Heart failure.

• To prevent infective endocarditis.

• To prevent development of

pulmonary vascular disease.

Medical management:1. Conservative management: a. Fluid restriction b. Diuretic theraphy c. Adequate calorie d. Ventilator support 2. Drugs: Indomethacin Ibuprofen

Indications of drugs:Prophylactic: Dose: 0.1 mg/kg/dose 24 hourly for 6

daysTiming: usually within 1st 24 hours of

life.Indication: All infant <1250gm birth

weight who have respiratory distress.

Therapeutic: Timing: usually within 1st 14 days of life.

Indications:

1. If there is any clinical sign of PDA In preterm baby.

2.There are signs of overt failure or congestive cardic failure.

3. Re-treatment after failure of the first course indomethacin

4. Rcurrence of PDA after first course of indomethacin

Dose of Indomethacin: O.2mg/kg stat followed by

<7days and birth weight <1250gm

0.1 mg/kg/dose 12 hourly for 2 doses

>7days and birth weight >1250gm

0.2 mg/kg/dose 12 hourly for 2 doses

Adverse effect: Renal dysfunction Gastro-Intestinal bleeding Thrombocytopenia Periventricular Leucomalasia

Contra-indication: Serum creatinine>1.8 mg/dl Renal or Gastrointestinal bleeding NEC Sepsis

Dose of Ibuprofen:

Initial dose of 10mg/kg followed at 24 hour intervals by two doses of 5mg/kg.

As Ibuprofen has less Adverse effect than Indomethacin, So Ibuprofen is superior than Indomethacin.

Catheter-based

Procedures:

Timing: usually done after

neonatal period

Indications:1. Small PDA with intra vascular coils.

2. Moderate to Large PDA with a catheter

introduced sac into which several coils

are released or with an umbrella-like

device.

Device used in Catheter-Based Procedures:

Catheter procedure:• Sedation

• A small incision is given in the inner thigh

• A long, thin, flexible, hollow tube is inserted through the femoral vein

• Implantation of device to PDA through tube.

Catheter based procedure:

Catheter based procedure:

Surgery:Indications:• A Premature or Full-term infant with symptomatic heart failure from the PDA in whom medical treatment has failed or in whom there is a contraindication to the use of drugs. • A PDA isn’t successfully closed by a Catheter-based Procedure.• Surgery is planned for treatment of related Congenital heart defects.

Timing: Usually after 6 months of

age.

Procedure: Ligation and division of ductus via a

Thoracotomy.

Complications: Bleeding

Pneumothorax

Chylothorax

Infection

Thoracic scoliosis

Surgical repair of PDA:

Surgery of PDA