DEFINITION
It is a condition in which a blood vessel called
the ductus arteriosus fails to close normally in
an infant soon after birth. (The word "patent"
means open.)
The condition leads to abnormal blood flow
between the aorta and pulmonary artery, two
major blood vessels surrounding the heart.
Heart With Patent Ductus
Arteriosus
The defect connects the aorta with the pulmonary
artery. This allows oxygen-rich blood from the aorta to
mix with oxygen-poor blood in the pulmonary artery.
A PDA allows blood to flow directly from the aorta into
the pulmonary artery and to the lungs. This extra
amount of blood flowing into the lungs strains the heart
and increases blood pressure in the lung's arteries.
Cause is unknown
Genetics may play a role. A defect in one or more
genes could prevent the ductus arteriosus from
closing normally after birth.
Infants with genetic disorders, such as Down syndrome
Infants whose mothers had German measles (rubella)
during pregnancy babies with congenital heart problems,
such as hypoplastic left heart syndrome, transposition of
the great vessels, and pulmonary stenosis
Occurs more often in premature infants (on average,
occurring in about 8 of every 1,000 births).
SIGNS & SYMPTOMS
Infants may not cause any symptoms
Common sign of PDA is HEART MURMUR
extra or unusual sound heard
during the heartbeat but is
harmless
may develop signs or symptoms of volume overload on
the heart and excess blood flow in the lungs including:
Fast breathing, working hard to breathe, or
shortness of breath
Poor feeding and poor weight gain.
Tiring easily.
Sweating with exertion, such as while feeding.
Tiring very easily
Bounding pulse
DIAGNOSTIC TESTS
Echocardiogram
- a painless test
that uses sound waves to
create a moving picture
of your baby's heart.
During echo, the sound
waves bounce off your
child’s heart.
Purpose:
• to diagnose & evaluate valvular abnormalities
• to measure & evaluate the size of the heart’s
chambers & valves.
Nursing Responsibilities:
• assist the child to remain still
• remove the conductive gel from the patients skin
Chest X-Ray
- a diagnostic test which uses invisible electromagnetic
energy beams to produce images of internal tissues,
bones, and organs onto film. With a PDA, the heart may
be enlarged due to larger amounts of blood flow through
the lungs than normal
Electrocardiogram(ECG/EKG)
- a simple, painless test that
records the heart's electrical
activity. For babies who have PDA,
an EKG can show whether the
heart is enlarged.
Purpose:
• to identify conduction abnormalities, cardiac arrhythmias,
myocardial ischemia or infarction(MI)
• to document pacemaker performance
Nursing Responsibilities:
• assist the patient to lie supine or semi-fowler’s position
during the procedure & expose the chest, ankles & wrists
• disconnect the equipment, remove the electrodes, &
remove the gel with a moist cloth towel after the procedure
MANAGEMENT
Medical
Indomethacin
Brand name: Indocin
C: NSAID
A: Stimulate the PDA to constrict or tighten, closing the
opening
I: inflammation
Ibuprofen
Brand name: Motrin
C: NSAID, Antipyretic, Anti-inflammatory
A: It may inhibit prostaglandin synthesis
I: Fever, minor aches and pains
Surgical
Surgical Division or Ligation
-A division of the patent vessel through a left
thoracostomy.
Visual Assisted Thoracoscopic Surgery(VATS)
- It uses a thorascope & instruments inserted through 3
small incisions on the left side of the chest to place a clip
on the ductus.
- It eliminates the need for a thoracostomy, thereby
speeding post-operative recovery.
Transcatheter Device Closure
- Often are used to close PDAs in infants or
children who are large enough to have the procedure.
- Sometimes is done on small PDAs to prevent the
risk of infective endocarditis (IE), an infection of the
lining of the heart, valves, or arteries
Nursing
Diagnosis
Ineffective Cardiopulmonary & Peripheral Tissue
Perfusion R/T Inadequate heart function
Nursing interventions
• Provide for rest periods
• Provide Oxygen as necessary
• Administer drugs as prescribed to strenghten heart
action
Nursing Outcome
•Child’s pulse, BP, & RR are within acceptable parameters for
age groups; abnormal heart sounds, edema & ascites are
absent.
Risk for imbalanced nutrition, less than body requirements
R/T Fatigue
Nursing interventions
• Promote pleasant, relaxing environment, including
socialization when possible
• Assist with oral care before ad after meals and at bedtime
• Promote adequate/timely fluid intake
Nursing Outcome
• Child maintains percentile curve on growth chart, skin
turgor is good
Activity Intolerance R/T Imbalance between oxygen
supple & demand
Nursing interventions
• Adjust activities to prevent overexertion
• Reduce intensity level or discontinue activities that cause
undesired physiological changes
PROGNOSIS
In premature babies with significant PDA there is risk
of broncho-pulmonary dysplasia. If a child with RDS is
found to have PDA too this is an adverse prognostic sign. If a
premature infant does not have RDS or it is uncomplicated,
the timing of spontaneous closure of the ductus is normal.
In most patients who have had successful closure of a PDA
there are no further complications.
Without treatments, Disease may progress from left-
to-right(acyanotic heart) shunt to right-to-left
shunt(cyanotic heart) called Eisenmenger syndrome.
REFERENCES
Adele Pillitteri. Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family Volume 2. Lippincott
Williams & Wilkins, 2007
http://www.nlm.nih.gov/medlineplus/ence/article/001560.html
http://www.nhlbi.nih.gov/health/dci/Diseases/pda/pda_links.ht
ml
http://www.healthsystem.virginia.edu/uvahealth/peds_cardiac/
pda.cfm
http://www.patient.co.uk/doctor/Patent-Ductus-
Arteriosus.html
THANK YOU!
