Patent Ductus Arteriosus (PDA)

Patent Ductus Arteriosus (PDA)

• Failure of the fetal ductus arteriosus to close within the first weeks of life, allowing blood to flow from the aorta to the pulmonary artery
• Causes a left-to-right shunt, which can lead to heart failure (HF), infective endocarditis, and pulmonary vascular obstructive disease
• Clinical manifestations: asymptomatic or widened pulse pressure, risk of HF
• Medical treatment: administration of indomethacin (prostaglandin inhibitor) to close the PDA
• Nonsurgical treatment: coils to occlude PDA placed in a catheterization laboratory
• Surgical treatment: may be necessary for some patients

Coarctation of the Aorta (COA)

• Localized narrowing near the insertion of ductus arteriosus
• Causes increased pressure proximal to the defect and decreased pressure distal to the obstruction
• Symptoms: high blood pressure in the upper arms, bounding pulses in the arms, weak or absent femoral pulses, cool lower extremities with lower blood pressure
• Signs of heart failure (HF) in infants, dizziness, headaches, fainting, epistaxis in older children
• Treatment: surgical repair is the treatment of choice for infants younger than 6 months, balloon angioplasty is the primary intervention for older children

Tetralogy of Fallot (TOF)

• Ventricular septal defect (VSD), pulmonic stenosis, right ventricular hypertrophy, and overriding aorta
• Clinical manifestations: some infants may be acutely cyanotic at birth, while others have mild cyanosis that progresses over the first year of life
• Signs and symptoms: acute episodes of cyanosis and hypoxia (blue spells or tet spells), risk of emboli, seizures, loss of consciousness, or sudden death
• Treatment: calming the baby and holding the baby in the knee-chest position to break the cycle, palliative treatment includes shunt or complete repair in the first year of life

Transposition of the Great Vessels (TGV or TPGA)

• The two great vessels of the aorta and pulmonary artery are reversed, resulting in cyanotic blood flowing to the brain
• Results in two separate circulatory systems—systemic and pulmonary
• Assessment and symptoms: poor feeding, profound cyanosis, tachypnea, signs and symptoms of CHF, chest x-ray “egg on a string” visualization
• Therapeutic management: providing intra-cardiac mixing, administration of intravenous prostaglandin E1 to keep the ductus arteriosus open, balloon atrial septostomy (Rashkind procedure) to increase mixing