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    Patent Ductus Arteriosus

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    suderi
    This patient is a 24-year-old female who was admitted to the hospital with shortness of breath that has worsened over the past few months. After examination, she was diagnosed with patent ductus arteriosus (PDA). Key findings included a continuous murmur and echocardiogram confirming a PDA. She is being treated medically with antibiotics, diuretics, and plans for an Amplatzer duct occluder procedure to close the duct. PDA is a congenital heart defect where the ductus arteriosus connecting the aorta and pulmonary artery fails to close after birth.

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    Patent Ductus Arteriosus

    Uploaded by

    suderi
    140 views31 pages
    This patient is a 24-year-old female who was admitted to the hospital with shortness of breath that has worsened over the past few months. After examination, she was diagnosed with patent ductus arteriosus (PDA). Key findings included a continuous murmur and echocardiogram confirming a PDA. She is being treated medically with antibiotics, diuretics, and plans for an Amplatzer duct occluder procedure to close the duct. PDA is a congenital heart defect where the ductus arteriosus connecting the aorta and pulmonary artery fails to close after birth.

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    This patient is a 24-year-old female who was admitted to the hospital with shortness of breath that has worsened over the past few months. After examination, she was diagnosed with patent ductus arteriosus (PDA). Key findings included a continuous murmur and echocardiogram confirming a PDA. She is being treated medically with antibiotics, diuretics, and plans for an Amplatzer duct occluder procedure to close the duct. PDA is a congenital heart defect where the ductus arteriosus connecting the aorta and pulmonary artery fails to close after birth.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    140 views31 pages

    Patent Ductus Arteriosus

    Uploaded by

    suderi
    This patient is a 24-year-old female who was admitted to the hospital with shortness of breath that has worsened over the past few months. After examination, she was diagnosed with patent ductus arteriosus (PDA). Key findings included a continuous murmur and echocardiogram confirming a PDA. She is being treated medically with antibiotics, diuretics, and plans for an Amplatzer duct occluder procedure to close the duct. PDA is a congenital heart defect where the ductus arteriosus connecting the aorta and pulmonary artery fails to close after birth.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 31

     Name : Mrs.

    MA
     Age : 24 years old
     Gender : Female
     Address : Toloa, South Tidore
     Medical Record : 783092
     Admitted : December 20th, 2017
     Chief complaint : Shortness of breath
     Shortness of breath has been
    experienced since childhood and
    worsened since a few month before
    admitted to the hospital. There is
    shortness of breath during activity. No
    shortness of breath while lying down. No
    history of chest pain. Patient has known
    her illness since childhood. No nausea
    and vomitting
    General Status :
    › Moderate ill
    › Nutritional Status : Good (BMI : 24,97 kg/m²)
     Weight : 60 kg
     Height : 1,55 m
    › Consciousness : Conscious
    Vital Sign
    › Blood Pressure : 100/60 mmHg
    › Pulse Rate : 90 bpm
    › Respiratory Rate : 16 rpm
    › Temperature : 36.4 °C
    Head and Neck Examination
    › Eye : conjunctia anemic (-/-), sclera icteric (-/-)
    › Lip : cyanosis (-)
    › Neck : no mass, no tenderness, JVP R+2 cmH2O
    Chest Examination
    › Inspection : symmetric left = right
    › Palpation : no mass, no tenderness, vocal
    fremitus left=right
    › Percussion : sonor left=right, lung-liver border in
    ICS VI right anterior
    › Auscultation : breath sound:vesicular ; additional
    sound: ronkhi (-), wheezing (-)
    Cardiac Examination
    › Inspection : apex was not visible
    › Palpation : apex was not palpable
    › Percussion : right heart border in right
    parasternal line, left heart border in left
    midclavicularl line ICS V
    › Auscultation : heart sound : S I/II regular;
    additional sound: continous murmur at
    upper left sternal border
    Abdominal Examination
    › Inspection : flat, following breath movement
    › Auscultation : peristaltic sound (+), normal
    › Palpation : no mass, no tenderness, no
    palpable liver and spleen
    › Percussion : tympani (+), ascites (-)
    Extremities Examination
    › Pretibial edema (-/-)
    › Dorsum pedis edema (-/-)
    › Cyanosis (-)
    Interpretation
     Sinus rhytm
     HR: 83 bpm
     Regular
     P wave : 0,08”
     PR interval : 0,08”
     QRS complex :
    0,10”, SV1+RV5=43
     Axis : normoaxis
    (55,6°)
     ST segmen : normal
     T wave : normal

    Conclussion : Sinus rhytm, HR:83 bpm, LVH


    TEST RESULT NORMAL TEST RESULT NORMAL
    VALUE VALUE
    WBC 7,6 x 103/uL 4.0 – 11.0 x 103 SGOT 21 u/L <38
    RBC 4,93 x 106/uL 4.0 – 6.0 x 106 SGPT 42 u/L <41
    HGB 13,7 g/dL 12 – 16 Ureum 26 10-50
    HCT 41 % 37 – 48 Creatinine 0,63 0,5-1,2
    PLT 233 x 103/uL 150 – 400 x 103 Natrium 143 136 - 145
    Kalium 3.1 3,5 - 5,1
    Chloride 100 97 - 111
    Patent Ductus Arteriosus
     IVFD  NaCL 0,9% 500 cc/24h/iv
     Antibiotic  Ceftazidine 1 g/12h/iv
     Diuretic  Furosemide 40 mg/24h/oral

     Duct closure  Amplatzer Duct


    Occluder (ADO)
    PATENT DUCTUS ARTERIOSUS
     The ductus arteriosus derives from the left
    sixth primitive aortic arch and connects
    the proximal left pulmonary artery to the
    descending aorta, just distal to the left
    subclavian artery.
     1 in 2000 birth  5% to 10 % of all
    congenital heart disease
     Include silent PDA  1 in 500 birth
     Female : male  2 : 1
     Premature
     Genetic abnormalities
     Infection and environmental factor
    The ductus arteriosus derives from the left
    sixth primitive aortic arch and connects
    the proximal left pulmonary artery to the
    descending aorta, just distal to the left
    subclavian artery.
    Left to Right Pulmonary Pulmonary
    Shunt overcirculation edema

    Hypertensive
    Increase stroke Increase flow
    Pulmonary
    volume and return to left
    vascular
    hypertrophy LV heart
    disease

    Increased
    Congestive
    contractility
    Heart Failure
    and heart rate
     Silent: tiny PDA detected only by nonclinical means
    (usually echocardiography)
     Small: continuous murmur common; Qp/Qs < 1.5 : 1
     Moderate: continuous murmur common; Qp/Qs of
    1.5 to 2.2 : 1
     Large: continuous murmur present; Qp/Qs > 2.2 : 1
     Eisenmenger: continuous murmur absent;
    substantial pulmonary hypertension, differential
    hypoxemia, and differential cyanosis (pink fingers,
    blue toes)
    A. Type A (“conical”) ductus, with well-
    defined aortic ampulla and constriction
    near the pulmonary artery end.
    B. Very large type B (“window”) ductus,
    with very short length.
    C. Type C (“tubular”) ductus, which is
    without constrictions.
    D. Type D (“complex”) ductus, which has
    multiple constrictions.
    E. Type E (“elongated”) ductus, with
    theconstriction remote from the anterior
    edge of the trachea.
    Symptoms
     Small PDA  asymptomatic
     Moderate  fatigue, dyspnea, palpitation
     Large  CHF with tachycardia, poor feeding, slow
    growth, recurrent lower respiratory tract infection

    Physical Examination
     continuous, machine-like murmur
     lower extremity cyanosis and clubbing
     Chest Radiograph  Normal,
    cardiomegaly , calcification of the
    ductus
     ECG  Normal, sinus tachycardia, atrial
    fibrillation, left ventricular hypertrophy,
    left atrial enlargement
     Echocardiogram  Confirm diagnosis
    and to characterize teh PDA
     MRI and CT  degree of calcification
     Cardiac Catheterization  unnecessary
    for diagnostic purposes
     Angiography  abnormal flow of blood
    through the PDA. Detailed assessment of
    the ductal anatomy
     Congestive Heart Failure

     Hypertensive Pulmonary Vascular


    Disease

     Endarteritis
     Infective arteritis was reported to be 1%
    per year
     Improved availability of health care,
    widespread use of antibiotics,
     Vegetations usually occur on the
    pulmonary artery end of the ductus, and
    embolic events are usually of the lung
    rather than the systemic circulation
     Diuretic and digoxin
     After load reduction  ACE Inhibitor
     Antidysrhythmia
     Endarteritis prophylaxis
    Transcatheter Surgical

     Treatment of choice  Ductal ligation or


     Amplatzer Duct division
    Occluder (ADO)  Very Large PDA
     No device closure
     Examined periodically for possible
    recanalization
     Silent residual shunts may be found by
    transthoracic echocardiography.
     Endocarditis prophylaxis is
    recommended for 6 months after PDA
    device closure or for life if any residual
    defect persists
     Isolated PDA  Excellent
     Adult  more dependent on the
    condition and status of pulmonary
    vascular and myocardium

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