foreign [Music] we will be walking through the patent ductus arteriosis to know more about other congenital heart defects and their classification you can watch our video on atrial septal defect patent ductus arteriosus or PDA is a congenital heart defect characterized by the failure of ductus arteriences to close within first few weeks of Life ductus arteriosus is an artery that connects the Iota and the pulmonary artery during the fetal life but it closes spontaneously after the birth however if it does not close and remain patent it gives rise to the congenital heart defect which we call the PDA or patent ductus arteriosus PDA allows blood to flow from higher pressure Iota to the lower pressure pulmonary artery creating a left to right shunt this leads to increased pulmonary blood flow the cause in most of the congenital heart effects is unknown however there are some factors that increase the chances of PDA these include premature birth about one in every 5 premature infants has PDA family history and genetic conditions like down syndrome rubella infection during pregnancy female gender it is twice as common in females than in males being born at a high altitude it occurs due to hypoxemia-induced failure of normal neonatal processes now the pathophysiology the hemodynamic consequences of PDA depend on the size of the ductus and the pulmonary vascular resistance at Birth the resistance in pulmonary and systemic circulations is almost identical so that the resistance in the iota and the pulmonary artery is equalized as the systemic pressure comes to exceed the pulmonary pressure blood begins to shunt from the Iota across the duct to the pulmonary artery creating a left to right shunt the additional blood is recirculated through the lungs and return to the left atrium and the left ventricle the effect is of altered circulation are increased workload on the left side of heart increased pulmonary vascular congestion and possibly resistance and potentially increased right ventricular pressure and hypertrophy the clinical manifestations or the signs and symptoms of PDA depend on the size of the opening if the opening is small the child may be asymptomatic and if it is large the child may have symptoms the symptoms may include continuous Machinery like murmur it can be heard during systral anti-stool it is heard best at the left upper sternal border the patient may also have endocarditis and increased heart rate wide pulse pressure pulse pressure is calculated by subtracting diastolic blood pressure from the systolic blood pressure a widered pulse pressure is defined as a difference between systolic and diastolic blood pressure of greater than 15 to 25 mm of mercury in premature infants and greater than 25 millimeters of mercury in term infants activity intolerance trouble feeding or tiredness during feeding poor weight gain frequent chest infections next we will discuss about the diagnosis of the patient ductus artery uses auscultation or listening to the characteristic continuous Machinery like murder which sounds like this [Music] echocardiography is the investigation of choice to diagnose PDA estimating magnitude of the shunt volume and to diagnose or exclude any Associated congenital heart defects just x-ray May demonstrate enlargement of the left ventricle and mean pulmonary artery cardiac catheterization can also reveal PDA ECG chains may also be seen especially in premature units with large PDA a T wave inversion and ST segment depression may be present now let's talk about the treatment of the PDA the administration of endomethacin has proved successfully in closing PDA in preterm infants the E-Series of prostaglandins are responsible for maintaining an openness of detectors arteriosis by dilation of the vascular smooth muscles throughout the fetal period endomethacin is a non-steroidal anti-inflammatory drug which inhibits prostaglandin production and leads to the closure of PDA the non-surgical treatment includes cardiac catheterization which allows the doctor to insert a soft wire mesh PDA closure device to stop blood flows through the patent ductus arteriosis the surgical treatment involves surgical Division and ligation of PDA via left thoracotomy let's now deal with the nursing management of PDA watch carefully for the science of PDA in premature infants frequently monitor the vital signs ECG electrolyte levels and input and output if infant receives indomethacin watch for the adverse effects such as diarrhea jaundice bleeding and renal dysfunction pre-operatively carefully explain all the treatment and testers to the parents post-operatively assess the science input and output and provide pain relief measures for the patient also administer the prescribed medications thank you for watching that was all about the beta nectus arterioses [Music]