Topics Discussed: airway management; alprostadil; arterial blood gas; blood circulation; cardiac catheterization; cardiology; cardiovascular examination and evaluation; congenital heart defect; congenital heart disease; electrocardiogram; fetus circulation; hyperoxia; indomethacin; neonatal circulation; neonatology; patent ductus arteriosus; pediatric cardiology; prenatal testing; vasoconstrictor agents.
Excerpt:"
- Fetal circulation (parallel) in transition to complete adult circulation (series)
- Is essentially a complete adult circulation in series, but with PDA and patent foramen ovale
- Potential for shunting exists, determined by relation between SVR and PVR
- Determinants of SVR
- Intrinsic autoregulatory mechanisms
- Environmental temperature
- Radiant warmer–induced vasodilation
- Determinants of PVR
- Alveolar hypoxia
- Reduced total pulmonary vascular bed
- Sensitization of pulmonary vascular bed by sustained asphyxia
- Large PDA can be diagnosed relatively accurately based on clinical findings.
- Small PDA usually requires an echocardiogram with Doppler, because findings may be similar to pulmonary disease or sepsis.
- Clinical findings of moderate to large PDA:
- Hypotension
- Murmur (Continuous, "machinery"-like, may be intermittent)
- Heart failure (Poor feeding, apnea, respiratory failure)
- Wide pulse pressure (>25 mm Hg)
- Hyperdynamic precordium
- Bounding pulses (± Palmar pulses, prominent pedal pulses)
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