Congenital Heart Disease: Patent Ductus Arteriosus
Patent Ductus Arteriosus (PDA) it is the vessel located at the junction of the lesser curvature of the descending aorta and the pulmonary artery (EL-Khuffash, Weisz, & McNamara, 2016). The vessel is distal to the subclavian artery.
The Murmur from a Mechanism view of the hearts physiological functioning
According to Yang et al, 2017, the occurrence of the PDA tends to be inversely related to the gestation weight and age of preterm infants. The normal development of an infant is highly dependent on the maintenance of ductal patency. However, the authors argue that the persistent patency of the ductus arterious(DA) also tends to be associated with the high morbidity and mortality rates in infants. The DA normally constricts at birth, resulting into intraluminal ischemic hypoxia. This leads to both the eventual closure as well as the remodeling of duct. Singh and Gooding (2016) also argue that while PDA in preterm infants is associated with maturity, it also tends to be associated with a functional defect in infants.
The inability of the PDA to close causes the ductus arterioles persistent patency. The systemic and pulmonary artery resistance during birth are almost usual, are usually, and are reflected in the aorta and PA. Therefore, shunting is minimal. The fall of the pulmonary resistance, cause the reversal of the fetal shunting. This causes the blood to shunt from left to right as well as from the aorta to the PA(Singh & Gooding, 2016). The increase in the pulmonary blood flow is associated with the increase in pulmonary venous return to the LA and the LV, and this increases the workload of the heart left side. The causes of the workload include an increase in the pulmonary venous return to the LA.
The discovery of the PDA May be delayed and can occur at a later stage in life. PDA may be discovered with the other abnormalities of the heart including the hole in the heart. Murmur is caused by the whole in the heart. The hole usually occurs in the intraventricular septum that separates between the right and the left ventricles. This causes the mixing of the oxygenated and deoxygenated blood. The blood pressure at the left ventricle has a higher pressure than in the right ventricle. The muscle of the left ventricle usually pumps blood at a
The epidemiology of the PDA
One neonate in every two thousand is born with the PDA. This accounts for over 5-10% of all the congenital heart diseases. The PDA incidences in the preterm neonates are extremely high and range from 20-60%. The result of this increase in preterm infant is caused by the lack of the required closure mechanism as a result of the immaturity (Yang et al., 2017). The gestational weight and age are associated with PDA in preterm neonates. For infants weighing 1.2 kg and below, the cases of PDA is approximate 80%. For infants weighing less than 2kg, the cases of PDA is approximate 40%. For infants weighing less than 1kg during birth, the presence of symptomatic PDA is approximate 48%. Preterm infants with respiratory distress syndrome (RDS) usually have the PDA at an approximate rate of 80%Slaughter, Reagan, Bapat, Newman, &Klebanoff, 2016). This is associated However with increased rate of prostaglandins circulation which is linked with the RDS. The PDA incidences are also associated with various birth factors such as exposure of users to rubella, genetic factors as well as high altitude at birth. Female infants have a higher rate of obtaining PDA as compared to the male infants. The mortality and morbidity rates of hemodynamic PDA is approximate 30% (Singh & Gooding, 2016). The issue if concern to preterm neonates considering they are faced with other complications.
PDA treatment
Three strategies are employed in treated of preterm infants with PDA. This includes surgical ligation, pharmacological management and watching waiting or fluid restriction. A fluid restriction is a conservative approach employed in the treatment of PDA. It involves the use of diuretics such as the loop diuretic furosemide(EL-Khuffash, Weisz, & McNamara, 2016). One of the advantages of this method is that infants are not exposed pharmacological agents associated with the side effects and the infants don’t need to undergo surgery. The method, however , is not very successful. Another method is pharmacological management. It involves the use of substances such as non-selective inhibitors with the aim of closing the PDA (Singh & Gooding, 2016). The use of surgery can also be used to close the PDA. It involves the use of litigation as well as the combination of litigation and DA division through the use of nonabsorbable suture or surgical clips.
References
EL-Khuffash, A., Weisz, D. E., & McNamara, P. J. (2016). Reflections of the changes in patent ductus arteriosus management during the last 10 years. Archives of Disease in Childhood – Fetal and Neonatal Edition, 101(5), F474-F478. doi:10.1136/archdischild-2014-306214
Singh, Y., & Gooding, N. (2016). Paracetamol for the Treatment of Patent Ductus Arteriosus in Very Low Birth Weight Infants. Journal of Neonatal Biology, 5(3). doi:10.4172/2167-0897.100e116
Singh, Y., & Gooding, N. (2016). Paracetamol for the Treatment of Patent Ductus Arteriosus in Very Low Birth Weight Infants. Journal of Neonatal Biology, 5(3). doi:10.4172/2167-0897.100e116
Slaughter, J. L., Reagan, P. B., Bapat, R. V., Newman, T. B., &Klebanoff, M. A. (2016). Nonsteroidal anti-inflammatory administration and patent ductus arteriosus ligation, a survey of practice preferences at US children’s hospitals. European Journal of Pediatrics, 175(6), 775-783. doi:10.1007/s00431-016-2705-y
Yang, Y., Zheng, H., Xu, Z., Zhang, G., Jin, J., Hu, H., … Zhou, X. (2017). Outcomes of Percutaneous Closure of Patent Ductus Arteriosus Accompanied With Unilateral Absence of Pulmonary Artery. The American Journal of the Medical Sciences, 353(4), 389-393. doi:10.1016/j.amjms.2017.01.018
