patent ductus arteriosus  
   

history

- history of PDA

history of PDA

- small PDA

- moderate PDA

- large PDA

   

physical examination

- physical examination of PDA

physical examination of PDA

- small PDA

- moderate PDA

- large PDA

   

investigation

- lab

- CXR

- EKG

- cardiac catheterization

 

CXR

- CXR finding

CXR finding

- cardiomegaly with increased pulmonary marking, enlarged pulmonary trunk

EKG

- EKG finding

EKG finding

- biventricular hypertrophy with left atrial abnormality then right ventricular hypertrophy

cardiac catheterization

- indication cardiac catheterization

- severity classification

indication cardiac catheterization

- intervention closure

- determine the operability

 

severity classification

- small

- moderate

- large

   

classification

- classification of PDA

- type of PDA by Krichenko classification

classification of PDA

- isolation

- combination

** pulmonary atresia

** hypoplastic left heart syndrome

** interrupted aortic arch

 

type of PDA by Krichenko classification

   

pathogenesis

- pathogenesis of PDA

pathogenesis of PDA

- patency of the ductus

- ductal constriction

** factor to close PDA

   

treatment

- steps of treatment

- supportive Rx

- transcatheter occlusion

- surgery

step of treatment

- 1st : pharmacological treatment 2-3 trial

- 2nd : surgery

supportive Rx

- medication

 

medication

- medication ให้ยาอะไรได้บ้าง

- ให้ dose ยาเท่าไร

- contraindication indomethacin

medication ให้ยาอะไรได้บ้าง

- indomethacin

- ibuprofen

 

ให้ dose ยาเท่าไร

 

contraindication indomethacin

transcatheter occlusion

- contraindication transcatheter occlusion

contraindication transcatheter occlusion

- large PDA > 4 mm with BW < 6 kg

- active endocarditis

- pulmonary hypertensioln with right-to-left shunt

surgery

- indication surgery

- contraindication surgery

- type of surgery

indication surgery

- symptomatic with term infant with heart failure

- asymptomatic with 1-2 yr of age

- medication x 2-3 trial not improve

 

contraindication surgery

- pulmonary resistance > 75% of systemic and unresponse to nitric oxide and oxygen

 

type of surgery

- VATS hemoclip occlusion

- conventional posterolateral thoracotomy and ligation

VATS hemoclip occlusion

- ข้อดีของ VATS hemoclip occlusion

- options for closure PDA

ข้อดีของ VATS hemoclip occlusion

- reduced patient discomfort

- reduced hospital stay

 

options for closure PDA

- long tortuous ductus : hemoclip occlusion

- short, wide ductus : Goretex band then tightened with several titanium clips

   

complication

- complication of PDA

complication of PDA

- heart failure

- infective endocarditis

- pulmonary hypertension