Persistent Ductus Arteriosus (PDA)

General information:

• The ductus arteriosus is a vascular connection between the pulmonary artery and the aortic arch (physiological situation in the fetal circulation).
  
• The ductus should close within the first days after birth, closing the fetal right to left circulation effectively.
  
• Hemodynamically effective shunt between the pulmonary artery and the aorta.

Symptoms:

• High cardiac output failure.
  
• Respiratory insufficiency, dependence on mechanical ventilation.
  
• Elevated pusatility index.

Diagnostic workout:

• Heart ultrasound (increased cardiac output; hypertrophic right ventricle).

Indication for conservative treatment/operation.

• Hemodynamically effective shunt.
  
• Exclude a shunt dependent heart malformation.
  
• Exclude a persistent pulmonary hypertension (PPHT).
  
• Thorbopenia (< 50000/mm3), recent bleeding, signs of renal insufficiency (urine volume < 1ml/kg BW/h)is a contraindication for conservative treatment (indomethacin, ibuprofen).

Treatment/Operation:

• Conservative treatment with indomethcin or ibuprofen (first dosage: 10 mg/kg BW Ibuprofenlysin®, after 24h: 5 mg/kg BW Ibupofenlysin®, after 48h: 5 mg/kg BW Ibuprofenlysin®).
  
• Operative closure trough a left lateral thoracotomy using a hemoclip.

Postoperative management:

• A chest tube for lung expansion, control of the hemostasis and drainage of secretions.

Prognosis:

• Good.
  
• Increase of the mean arterial blood pressure.