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Patent Ductus Arteriosus
Transcatheter closure of patent ductus arteriosus: Transcatheter closure has proven to be an excellent treatment option for children with patent ductus arteriosus. First reported in 1967, this procedure is done in the heart catheterization laboratory with conscious sedation and avoids the need for surgery. (rollover to compare with normal), What Is It? A Ductus Arteriosus is a fetal vessel necessary to support the fetal circulation while in utero. This vessel sometimes.
What is patent ductus arteriosus? Patent ductus arteriosus (PDA) occurs when a blood vessel that is normal while a baby in the womb fails to close after the baby is born.
The cause of the problem is not known and it affects one in 2000 babies that are born each year. It is more common in girls and much more common in premature infants.
It may occur in children with otherwise normal hearts and occurs commonly in association with complex heart defects such as hypoplastic left heart syndrome, transposition of the great arteries, coarctation of the aorta, and pulmonary atresia. Dispositivo pci driver for mac download. The information on this page applies primarily to patients with patent ductus arteriosus and otherwise normal hearts. While a baby is in the womb, the mother provides oxygen and the baby's lungs are filled with fluid. Blood flow during this time bypasses the lungs through a blood vessel that connects the pulmonary artery (1) with the aorta (2). This blood vessel is called the ductus arteriosus (3). When it remains open after birth it is called a patent ductus arteriosus. In most babies it remains open for a short period of time after birth but 90% will be closed by 8 weeks of age.
Most of the rest will close during the first year of life. While the baby is in the womb, the fluid in the lungs causes high pressure so blood entering the pulmonary artery takes the path of least resistance bypassing the lungs and flowing out to the aorta through the ductus arteriosus. After birth, the lungs fill with oxygen so the pressure in lungs and the pulmonary artery goes down. At the same time, the umbilical cord is clamped and the pressure in the aorta increases.
As a result, the pressure in the pulmonary artery is lower than the pressure in the aorta so some of the blood in the aorta flows through the ductus back to the lungs. This results in extra blood flow to the lungs. If the ductus is small, the extra blood flow is minimal but if the ductus is large, there can be a large amount of blood returning to the lungs causing a significant increased workload for the heart. What are the effects of this problem on my child's health?
The effects of patent ductus arteriosus relate largely to the size of the ductus. Babies born very prematurely are more sensitive to the extra pulmonary blood flow so are more likely to have heart related symptoms. If the extra blood flow taxes the heart too much, symptoms of congestive heart failure develop. This is not uncommon in premature infants but is quite rare in full term infants or older children. Symptoms of congestive heart failure include rapid breathing, feeding problems, slow weight gain, low energy, and cold, clammy sweating. If the PDA remains large, over time the extra blood flow damages the pulmonary artery and they become stiff and thickened.
This condition, called pulmonary vascular disease is a very serious problem for which there is currently no effective treatment. Children with patent ductus arteriosus are also at increased risk for subacute bacterial endocarditis (SBE). This is an infection of the heart caused by bacteria in the blood stream. It can occur after a dental or other medical procedure but can usually be prevented by a dose of antibiotic prior to the procedure. Children with small PDAs are at even greater risk for SBE than children with large PDAs.
For this reason, many doctors recommend closure of even small PDAs. Exercise recommendations: Exercise recommendations are best made by a patient's doctor so that all relevant factors can be included in the decision. In general, exercise restrictions for patients with patent ductus arteriosus are not necessary and children can participate in competitive and vigorous athletic activities.
How is this problem diagnosed? Clinical findings: Most children with PDA do not have heart related symptoms.
If the ductus is large in size, symptoms of congestive heart failure may develop. Congestive heart failure can develop at any time but more commonly presents during the first 2 to 3 months of life. The symptoms include rapid breathing, poor feeding, slow growth, and cold, clammy sweating.
Physical findings: A heart murmur is often the only clue that a child has a PDA. If the child is in congestive heart failure, there will be poor weight gain, the heart rate and breathing rate will be higher than normal, and the liver will be enlarged. Medical tests: Medical tests that provide helpful information include an electrocardiogram, oxygen saturation test, and chest x-ray.
The diagnosis is confirmed by an echocardiogram. How is the problem treated?
As described earlier, small PDAs do not cause symptoms so generally treatment (other than SBE prophylaxis) is not needed. Many children will have spontaneous closure of the ductus during the first year of life. If the child develops congestive heart failure medications may be prescribed including digoxin and/or diuretics. These medications often control the symptoms until the child gets bigger and the PDA gets smaller or closes altogether. If the patent ductus does not close spontaneously by one or two years of age or if there are symptoms of congestive heart failure that are not controlled by medication, closure of the defect is recommended.
Closure of very small or 'silent' patent ductus arteriosus may also be recommended to reduce the risk for bacterial endocarditis. Treatment options include closure via heart catheterization or surgical closure. A medicine called indomethacin is often used to close the ductus in premature infants. Transcatheter closure of patent ductus arteriosus: Transcatheter closure has proven to be an excellent treatment option for children with patent ductus arteriosus. First reported in 1967, this procedure is done in the heart catheterization laboratory with conscious sedation and avoids the need for surgery. During the procedure, catheters (thin plastic tubes) are placed into the large blood vessels in the legs and gently guided to the heart. These catheters are used to deposit small metal coils within the ductus.
The coils obstruct blood flow through the vessel, in part by stimulating the development of a blood clot at the site. This procedure achieves an excellent result in most patients. Complications are rare and include bleeding, infection, and early dislodgment of the coil. If the coil dislodges it can usually be retrieved at the time of the procedure and repositioned or replaced with a larger size coil. The procedure is done as an outpatient and children can resume all activities within 48 hours.
Surgical closure of patent ductus arteriosus: Surgical results are also excellent. Surgery is the preferred treatment for a large PDA and/or if closure is required during infancy. It is done through a small incision between the ribs on the left side. The ductus is identified and either tied off or divided.
Surgical complications are rare and include hoarseness or paralyzed diaphragm, infection, bleeding, and accumulation of fluid around the lungs. Most children go home two or three days after the surgery. Clinics Care and services for patients with this problem are provided in the Congenital Heart, Interventional Cardiology and Cardiovascular Surgery clinics at the University of Michigan Medical Center in Ann Arbor. What is the outlook for children with this problem?
The outlook for these patients is excellent as long as treatment is initiated soon enough to prevent pulmonary vascular obstructive disease. Possible long-term complications include coarctation (narrowing of the aorta) or recurrence of the vessel although both problems are extremely rare. References Lloyd TR, Fedderly R, Mendelsohn AM et al. Transcatheter occlusion of patent ductus arteriosus. Circulation 19-1420. Mullins CE & Pagotto L.
Patent ductus arteriosus. In Garson A, Bricker J, Fisher D & Neish S (Eds), The science and practice of pediatric cardiology.
Williams & Wilkins: Baltimore, MD, 1181-1197. Left-to-right shunt lesions. In Pediatric cardiology for practitioners.
Mosby-Year Book: St Louis, MO, 1996,142-145. Shim D & Beekman RH. Transcatheter management of patent ductus arteriosus. Pediatr Cardiol 1998:19;67-71. Written by: S. LeRoy RN, MSN Reviewed September, 2012.
The ductus arteriosus is a fetal vessel that connects the pulmonary artery to the descending. In patent ductus arteriosus (PDA), the lumen of the ductus remains open after birth. This creates a left to right of blood from the aorta to the pulmonary artery and results in recirculation of pulmonary blood through the.
The prognosis is good if the shunt is small or surgical repair is effective. Pathophysiology The pathophysiology of patent ductus arteriosus stems from the following: Non-modifiable Factors. Genetics: Congenital heart defects appear to run in families and sometimes occur with other genetic problems, such as.
Age: Patent ductus arteriosus is more common in premature babies. Also, babies with other types of congenital heart defects often have a patent ductus arteriosus. Gender: PDA is twice as common in girls as in boys.
Modifiable Factors Experiencing any of the following conditions during pregnancy can increase the risk of having a baby with a heart defect. Rubella: Becoming infected with rubella (German ) while pregnant can increase the risk of fetal heart defects. The rubella virus crosses the and spreads through the fetus’s circulatory system damaging blood vessels and organs, including the heart. Poorly controlled: Uncontrolled in the mother in turn affects the fetus’s blood sugar causing various damaging effects to the developing fetus.
Drug or alcohol use or exposure to certain substances: Use of certain medications, alcohol or drugs, or exposure to chemicals or radiation during pregnancy can harm the developing fetus. Presence of other congenital heart defects. Babies with other types of congenital heart defects often have a patent ductus arteriosus. Statistics and Incidences Patent ductus arteriosus is the most common congenital heart defect among adults.
PDA is found in 1 of every 2, 500 to 5, 000 infants. It affects twice as many females as males. Causes Normally, the ductus arteriosus closes within days to weeks after birth, and the failure to close may be attributed to the following factors:. Prematurity.
PDA is most prevalent in premature neonates, probably as a result of abnormalities in oxygenation. Prostaglandin E. The relaxant action of prostaglandin E prevents ductal spasm and contracture necessary for closure. Other congenital defects. PDA commonly accompanies rubella syndrome and may be associated with other congenital defects, such as coarctation of the aorta, ventricular septal defect, and pulmonary and aortic stenoses. Clinical Manifestations Initially, PDA may produce no clinical effects, but in time it can precipitate pulmonary vascular disease, causing symptoms to appear by age 40.
Respiratory distress. A large PDA usually produces respiratory distress. There are signs of heart failure due to the tremendous volume of blood shunted to the lungs through a patent ductus and the increased workload on the left side of the heart. Low immune system.
The patient has a high susceptibility to respiratory tract infections. Slow motor development. The patient’s motor skills expand and develop slower than the average person does.
Physical underdevelopment. One of the signs of heart disease is the physical underdevelopment of the patient’s body. Heart murmur.
Auscultation reveals a continuous murmur best. Bounding peripheral pulses. Peripheral arterial pulses are bounding; also called Corrigan’s pulse. Widened pulse pressure.
Pulse pressure is widened because of an elevation in the systolic, and primarily, a drop in the diastolic pressure. Complications Patent ductus arteriosus, if left untreated, could lead to the following:. Left-sided heart failure. The left-to-right shunting of the blood renders the cardiac muscles of the left chamber overworked and leads to heart failure. Pulmonary artery. There is increased pulmonary venous return leading to pulmonary.
Assessment and Diagnostic Findings Patent ductus arteriosus is diagnosed by the following:. Chest x-ray. Chest x-ray may show increased pulmonary vascular findings, prominent, and left and aorta enlargement. Electrocardiography (ECG). ECG may be normal or may indicate left atrial or ventricular hypertrophy and in pulmonary vascular disease, biventricular hypertrophy. Echocardiography. Echocardiography detects and helps determine the size of PDA.
Medical Management Asymptomatic children do not require immediate treatment but those with heart failure require the following:. Fluid restriction. Fluids should be restricted or controlled to avoid overloading the heart. Pharmacologic Therapy Medications for the patient with PDA include:. Prostaglandin analogs. The ductus arteriosus can be induced to remain open by administering prostaglandin analogs such as (a prostaglandin E 1 analog).
Before, children with PDA require antibiotics to protect against infective endocarditis. Indomethacin is a prostaglandin inhibitor that’s an alternative to surgery in premature neonates and induces ductus spasm and closure. Surgical Management Other forms of therapy include surgical interventions such as:. In cardiac, a plug or coil is deposited in the ductus to stop the shunting. The DA may be closed by ligation, wherein the DA is manually tied shut, or with intravascular coils or plugs that leads to formation of a in the DA.
Nursing Management Nursing management for a patient with patent ductus arteriosus include: Nursing Assessment Assessment should focus on:. Activity and rest. The nurse should assess for weakness, dizziness, a sense of pulsing, and even sleep disorders. Circulation. Circulatory assessment should include history trigger conditions, history of heart murmurs and palpitations, BP, and pulse pressure. Food and fluids. The nurse should assess for and changes in body weight.
Based on the assessment data, the major include:. related to imbalance between oxygen consumption of the body and supply of oxygen to the cells.
related to hospital care or lack of support system. related to the condition and treatment needs. & Goals The major goals for the patient are:. Maintain adequate cardiac output. Reduce the increase in pulmonary vascular resistance.
Maintain adequate levels of activity. Provide support for growth and development. Maintain appropriate weight and height development.
Patent Ductus Arteriosus Pathophysiology
Nursing Interventions Patent ductus arteriosus necessitates careful monitoring, patient and family teaching, and emotional support. Signs and symptoms.
Watch carefully for signs of PDA in premature infants. Monitoring.
Frequently assess vital signs, ECG, electrolyte levels, and intake and output. Adverse effects of indomethacin. If the infant receives indomethacin for ductus closure, watch for possible adverse effects, such as, jaundice, and renal dysfunction. Preoperative instructions. Before surgery, carefully explain all treatments and tests to parents, including the child, and tell them about expected IV lines, monitoring equipment, and postoperative procedures. Postoperative procedures.
Immediately after surgery, the child may have a central venous pressure catheter and an arterial line in place, so careful assessment of vital signs, intake and output, and arterial and venous pressures are needed, as well as relief. Evaluation Expected outcomes include:.
Reduced the increase in pulmonary vascular resistance. Maintained adequate levels of activity.
Provided support for growth and development. Maintained appropriate weight and height development. Discharge and Home Care Guidelines Before discharge, the following should be reviewed with the patient and the family:. Instructions. Review instructions with parents about activity restrictions based on the child’s tolerance and energy levels.
Activities. Advise the parents not to be overprotective as the child’s tolerance for physical activity increases.
Follow-up checkups. The need for regular follow-up examinations. Advise parents to inform any practitioner who treats his child about his history of surgery for PDA-even if the child is treated for an unrelated medical problem. Documentation Guidelines The focus of documentation should include:. Client’s understanding of individual risks and safety concerns. Availability and use of resources.
Current and previous level of function. Level of and precipitating/aggravating factors. Description of feelings. Awareness and ability to recognize and express feelings. Plan of care. Teaching plan. Client involvement and response to interventions, teaching, and actions performed.
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Attainment or progress toward desired outcomes. Modifications to plan of care. Long term needs.
Practice Quiz: Patent Ductus Arteriosus Here’s a 5-item quiz about the study guide. D: The ductus arteriosus is a fetal blood vessel that connects the pulmonary artery to the descending aorta. A: The pulmonary vein is one of four vessels that carry aerated blood from the lungs to the left atrium of the heart. B: The left ventricle is the left lower chamber of the heart that receives blood from the left atrium and pumps it out under high pressure through the aorta to the body. C: Ligamentam arteriosum is a cord of tissue that connects the pulmonary trunk and the aorta and that is the vestige of the ductus arteriosus.
D: The ductus arteriosus is a fetal blood vessel that connects the pulmonary artery to the descending aorta. A: The pulmonary vein is one of four vessels that carry aerated blood from the lungs to the left atrium of the heart. B: The left ventricle is the left lower chamber of the heart that receives blood from the left atrium and pumps it out under high pressure through the aorta to the body. C: Ligamentam arteriosum is a cord of tissue that connects the pulmonary trunk and the aorta and that is the vestige of the ductus arteriosus. An infant with a patent ductus arteriosus is admitted to the pediatric unit ward.
The nurse anticipates which of the following medications will be given to the infant?. B: When surgical ligation is not indicated, prostaglandin inhibitors (e.g., nonsteroid anti-inflammatory drugs ) are used to close the ductus arteriosus. A, C, D: Options A, C, and D are not used for the management of patent ductus arteriosus. A premature baby might have the option of medical treatment of a PDA by way of administration of: A. D: Indomethacin is a prostaglandin inhibitor that’s an alternative to surgery in premature neonates and induces ductus spasm and closure. A, B, C: The following medications are not administered to a patient with patent ductus arteriosus.
A patent ductus arteriosus can lead to: A. Left-sided heart failure. Right-sided heart failure. D: PDA could cause both cyanosis and left-sided heart failure as the left-to-right shunting of the blood renders the cardiac muscles of the left chamber overworked and leads to heart failure and cyanosis. C: Right-sided heart failure does not occur in PDA as the shunting of the blood is from left to right, hence the most affected and overworked part is the left side of the heart. The structure that connects the aorta to the pulmonary artery in utero is known as the: A.
Patent Ductus Arteriosus Surgery
Pulmonary vein. Ligamentam arteriosum. Ductus arteriosus. Ductus arteriosus.
D: The ductus arteriosus is a fetal blood vessel that connects the pulmonary artery to the descending aorta. A: The pulmonary vein is one of four vessels that carry aerated blood from the lungs to the of the heart. B: The left ventricle is the left lower chamber of the heart that receives blood from the left and pumps it out under high pressure through the aorta to the body. C: Ligamentam arteriosum is a cord of tissue that connects the pulmonary trunk and the aorta and that is the vestige of the ductus arteriosus. When assessing a diagnosed with patent ductus arteriosus, Nurse Olivia should expect that the child most likely would have an: A. Loud, machinery-like murmur.
Bluish color to the lips. Decreased BP reading in the upper extremities. Increased BP reading in the upper extremities. Loud, machinery-like murmur. A: A loud, machinery-like murmur is a characteristic finding associated with patent ductus arteriosus. B, C, D: The following symptoms are not associated with patent ductus arteriosus.
See Also Related posts:. Further Reading and Recommended Resources Recommended books and reading materials:.
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