what is patent ductus arteriosus? explained in tamil[PDA in children ]MED TAMIL

Patent ductus arteriosus tamil
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Persistent ductus arteriosus
cvs
Great blood vessel
Pulmonary artery tamil
Heart circulation in tamil
Cardiac vascular system tamil
high blood pressure
circulatory system
Blood pressure in tamil
Patent ductus arteriosus tamil

Aetiology
During fetal life, before the lungs begin to function, most
of the blood from the pulmonary artery passes through
the ductus arteriosus into the aorta . Nor-
mally, the ductus closes soon after birth but sometimes
fails to do so. Persistence of the ductus is associated with
other abnormalities and is more common in females.
Since the pressure in the aorta is higher than that in
the pulmonary artery, there will be a continuous arterio-
venous shunt, the volume of which depends on the size
of the ductus. As much as 50% of the left ventricular
output is recirculated through the lungs, with a conse-
quent increase in the work of the heart
Clinical features
With small shunts there may be no symptoms for years
but, when the ductus is large, growth and development
may be retarded. Usually, there is no disability in infancy
but cardiac failure may eventually ensue, dyspnoea
being the first symptom. A continuous 'machinery'
murmur is heard with late systolic accentuation, maximal
in the second left intercostal space below the clavicle (see
It is frequently accompanied by a thrill.
Pulses are increased in volume.
A large left-to-right shunt in infancy may cause a
considerable rise in pulmonary artery pressure and
sometimes this leads to progressive pulmonary vascular
damage. Enlargement of the pulmonary artery may be
detected radiologically. The ECG is usually normal.
Persistent ductus with reversed shunting
If pulmonary vascular resistance increases, pulmonary
artery pressure may rise until it equals or exceeds
aortic pressure. The shunt through the defect may then
reverse, causing Eisenmenger's syndrome. The murmur
becomes quieter, may be confined to systole or may
disappear. The ECG shows evidence of right ventricular
hypertrophy.
Management
A patent ductus is closed at cardiac catheterisation with
an implantable occlusive device. Closure should be
undertaken in infancy if the shunt is significant and
pulmonary resistance not elevated, but this may be
delayed until later childhood in those with smaller
shunts, for whom closure remains advisable to reduce
the risk of endocarditis.
Pharmacological treatment in the neonatal period
When the ductus is structurally intact, a prostaglandin
synthetase inhibitor (indometacin or ibuprofen) may be
used in the first week of life to induce closure. However,
in the presence of a congenital defect with impaired lung
perfusion (e.g. severe pulmonary stenosis and left-to-
right shunt through the ductus), it may be advisable
to improve oxygenation by keeping the ductus open
with prostaglandin treatment. Unfortunately, these
treatments do not work if the ductus is intrinsically
abnormal.
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