View source for Patent ductus arteriosus

==Background==
*Ductus arteriosus is a blood vessel connecting main pulmonary artery to proximal descending aorta
**Shunts blood from right ventricle to bypass fetus's non-functioning lungs in utero
*In PDA, ductus fails to close after birth
*Second most common congenital heart disease
*Approximately 1 in 1600 to 5000 live births in the US.<ref>Mitchell, S. C., Korones, S. B., Berendes, H. W. Congenital heart disease in 56,109 births: incidence and natural history. Circulation 43: 323-332, 1971.</ref>

===Pathophysiology===
[[File:PDA.png|thumb]]
*Ductus arteriosus shunts blood from the pulmonary artery to the aorta bypassing the lungs while in utero
*Normally closes soon after birth via complex process
**Regulated by oxygen tension and decreases in prostaglandin E2
**Becomes ligamentum arteriosum
*In PDA, ductus fails to close
**Results in shunting of blood between aorta and pulmonary artery
**Some oxygenated blood from high-pressure aorta shunts to lower pressure pulmonary artery
**A large shunt can cause increased fluid return to lungs and increased lung pressure, leading to [[pulmonary hypertension]]
*Some congenital heart defects, such as [[transposition of the great arteries]], are incompatible with life ''''without''' a PDA; may be necessary to allow oxygenated and deoxygenated blood to mix
**In these cases [[prostaglandin E1|prostaglandins]] are used to keep the ductus arteriosus '''open'''.

==Clinical Features==
* Continuous machine like heart [[murmur]]
* Differential cyanosis (cyanosis of lower extremities and not the upper extremities)
* [[Dyspnea]]
* [[Tachycardia]]
* Widened pulse pressure
* [[Congestive heart failure]]
* [[Failure to thrive (peds)|Failure to thrive]]

==Differential Diagnosis==
* [[Acute pericarditis]]
* Aortopulmonary Septal Defect
* [[Coarctation of the Aorta]]
* [[Anomalous coronary arteries|Coronary artery fistula]]
* Pediatric acute [[respiratory distress syndrome]]
* Sinus of valsalva aneurysm
* Pediatric [[tachycardia]]
* Pulmonic valvular stenosis
* [[Sickle cell anemia]]
* [[Tetralogy of Fallot]] with absent pulmonary valve

{{Congenital heart disease DDX}}

==Evaluation==
[[File:PDA Fomani.gif|thumbnail|Echocardiography demonstrating PDA<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]
* Careful physical examination demonstrating characteristic machine like murmur
* [[Echocardiography]]
**MRA and Cardiac CT can also be used as diagnostic tools
*Laboratory tests usually not helpful

==Management==
*Spontaneous closure common
*If significant [[shortness of breath (peds)|respiratory distress]] or impaired oxygen delivery, therapy usually required  

=== Medical Therapy ===
*IV [[indomethacin]]: usually effective when administered in the first 10-14 days of life.  
**<48 hour old: start 0.2mg/kg IV x 1, then 0.1mg/kg q12-24h x 2
**2-7 days old: Start 0.2mg/kg IV x 1, then 0.2mg/kg q12-24h x 2
**> 7 days old: Start 0.2mg/kg IV x 1, then 0.25mg/kg q12-24h x 2

=== Surgical Therapy ===
*Offered if medical therapy fails
**Cardiac catheterization and catheter closure
**Surgical ligation

==Disposition==
*Stable, asymptomatic patients can be discharged home with cardiology follow-up
*Symptomatic patients and patients requiring treatment should be admitted with cardiology consultation

==See Also==
*[[Congenital Heart Disease]]

==External Links==


==References==
<references/>


[[Category:cardiology]]
[[Category:Pediatrics]]