Persistent Ductus Arteriosus (PDA)
- 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.
- High cardiac output failure.
- Respiratory insufficiency, dependence on mechanical ventilation.
- Elevated pusatility index.
- 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).
- 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.
- A chest tube for lung expansion, control of the hemostasis and drainage of secretions.
- Increase of the mean arterial blood pressure.
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