SlideShare a Scribd company logo
Welcome to
Grand Session
Particulars of the patient
Name- Minu Akter
Age- 1 year.
Sex- Female.
Religion- Islam.
Address- Moghbazar, Dhaka.
Informant- Mother.
Date and time of admission- 10/06/2021
Date and time of examination- 11/06/2021
Chief complaints
• Fever for four days
• Cough and cold for 4 days
• Breathlessness for 2 days
• Not growing well since her early infancy
History of present illness
• According to the statement of the informant (mother) baby was relatively well
four days back then she developed fever, which was low grade intermittent in
nature, not associated with chills and rigor, highest recorded temperature was
101ᵒF, Fever subsided after taking antipyretics with little or no sweating.
• Mother also complained of cough and running nose for same duration. Cough
present throughout day and night, without any particular aggravating and reliving
factor.
• The baby had breathlessness for last two days, which made her difficulty in
feeding, feeding is associated with suck rest and suck cycles.
H/O present illness cont….
• This breathlessness has no diurnal, seasonal variation and not related
to exposure to cold, dust, pollen, fume etc.
• Mother also complained that her baby’s weight is not gaining since
her 3-4 moths of age.
• There is no history of bluish discoloration of skin, finger nail, toes and
lips.
History of past illness
• She had history of repeated lower respiratory tract infection. Patient
required 2 times hospitalization for pneumonia in 3 months apart. She
was treated with iv antibiotics, oxygen, nebulization along with other
medications.
Drug history
• Baby has been taking syrup Frusemide and table Spironolactone
for last six months as prescribed by the doctor.
• Now she is currently on some injectable and syrup which increase the
urine output along with multivitamins.
Birth history
Antenatal- Mother was under regular ante natal checkup and her pregnancy
was uneventful.
no h/o fever, rash, in mother during antenatal period
no h/o drug intake, smoking and alcohol intake
no h/o DM, HTN
Natal- born by FTNVD/wt 3kg/no h/o NICU admission
Postnatal- Baby cried immediately after birth. No h/o cyanosis/prolong
jaundice/ petechae /seizure in NB Period
Feeding history
• Baby received exclusive breast feeding for first six months, then
weaning was started with soft rice, suzi, khichuri. Now the baby is on
family diet.
Immunization history
Immunization is upto date according to EPI schedule.
Developmental history
• Developmentally she is age appropriate.
Family history
• Baby is the second issue of her non consanguineous parent. Her elder
brother and her parents are healthy.
• The is no h/o of congenital heart disease in the family.
Allergic history
Nothing significant.
Socioeconomic history
• Belongs to a lower socioeconomic condition. Lives in semi paka house,
drinks water from tube well. Father is a service holder and mother is
housewife.
General examination
 Appearance- Ill looking.
 Body build- Below Average.
 Decubitus- On choice.
 Anemia- Absent.
 Jaundice- Absent.
 Cyanosis-Absent.
 Koilonychias- Absent.
 Leuconychia- Absent.
 Clubbing- Absent.
 Edema- Absent.
 Dehydration- Absent.
 Thyroid- Not enlarged.
 Lymph node- Not palpable.
 JVP-Not raised.
vitals
• Pulse Rate- 160/min, regular, high volume, no radio radial and
radiofemoral delay
• RR- 55/min
• Temp-101ᵒF
• BP-90/40 mm of Hg.
• Spo2- 98% in room air
Anthropometric measurement
Height – 71 cm.
Weight – 7.2 kg.
• Weight for age Z-Score : -2.94
• Weight for length Z-Score : -2.28
• Height for age Z-Score: -2.1
Occiput frontal circumference (OFC) – 44 cm (5th centile)
Mid upper arm circumference (MUAC) – 12.5 cm.
Cardiovascular system examination
Inspection:
Precordium is normal in size and shape
visible apex beat present
No scar mark,
no venous engorgement
Palpation:
Apex beat is situated left fifth intercostal space just lateral to mid clavicular line.
Thrusting in nature
Thrill – Systolic thrill present in the upper left sternal border.
Left parasternal heave – absent.
No palpable P2
Auscultation:
heart rate-160/min, rhythm regular
1st and 2nd heart sound is inconspicuous,
There is harsh continuous machinery murmur at upper left sternal edge with systolic
accentuation. Grade 4/6, which radiate to left infraclavicular area
Respiratory system examination
Inspection:
• Shape and size of the chest is normal.
• Fast breathing with respiratory rate 56 breaths/min.
• Subcostal and Intercostal recession – Present.
Palpation:
• Trachea centrally placed.
• Apex beat in left fifth intercostal space just lateral to MCL
Percussion: Bilaterally resonant
Auscultation:
Vesicular breath sound
Crepitation present in both lungs field more marked in medial and lower zones
Alimentary system
Inspection:
• Oral cavity normal in appearance, tongue is moist, tonsil show no
signs of inflammation
• Abdomen normal in shape and size. Umbilicus centrally placed and
inverted. No scar mark. No venous engorgement.
Palpation: abdomen is soft, nontender and liver is enlarged, 3 cm from
rt costal margin, surface smooth, soft in consistency, upper border of
liver dullness on rt 5th intercostal space.
Percussion: tympanic, no ascites
Auscultation: Bowel sound present
Salient features
Minu Akter, 1 year old female baby hailing from Moghbazar, Dhaka,
came with complaints of Fever for 4 days, which was low grade
intermittent in nature and subsided by taking antipyretics. Mother also
complaints of cough, running nose for four days and breathlessness
for last 2 days which made her difficulty in feeding, her feeding is
associated with suck rest and suck cycles. She has recurrent history of
RTI. There is no history of bluish discoloration of skin, finger nail, toes
and lips. On examination baby is ill looking, febrile, dyspnoic, and
tachypnea and tachycardia is present, She is acyanotic, non edematous.
Baby is moderately wasted and stunted.
Salient features contd….
High volume pulse with wide pulse pressure present. Apex beat is
situated left fifth intercostal space just lateral to mid clavicular line which
is thrusting in nature . Systolic thrill present on the left upper sternal
edge. 1st and 2nd heart sound is inconspicuous, there is a continuous
machinery murmur best heard at upper left sternal edge, Grade 4/6,
which radiate to left infraclavicular area. Intercostal and subcostal
recession present. Breath sound is vesicular with crepitation present in
middle and lower zone of both lung field, There is hepatomegaly. Other
systemic examination revealed normal findings .With these complaints
he has been admitted to BSMMU for further management.
Provisional diagnosis
• Acyanotic congenital heart disease most probably Patent Ductus
Arteriosus (PDA) with heart failure with Pneumonia with FTT.
Points in favour
PDA Heart failure Pneumonia
Acyanotic Tachycardia Fever
High volume pulse with
wide pulse pressure
Tachypnea Dyspnea
Thrusting apex beat Enlarge tender liver Intercostal and subcostal
recession
Continuous machinery
murmur
Cardiomegaly Crepitation
Bilateral basal crepitation
Differential diagnosis
DD Points in favors Points against
Aortopulmonary window Clinical presentation are similar to
PDA
Bounding peripheral pulse, wide
pulse pressure
• More in Male
• Continuous murmur is more
pronounce on the left 3rd
intercostal space
Venous hum Continuous murmur
Best heard in infraclavicuar area
• Pt is clinically normal
• It is audible only in upright
position
• Disappear in supine position
• It is best heard on the right
side
• It is also change with position
of neck
Rupture sinus of valsulva Features of heart failure
Continuous murmur
Sudden onset chest pain, with
dyspnea,
Investigations
• Chest X-Ray:
ECG
Echocardiography
• A moderate sized PDA (4
mm) with L-R shunt (PPG
73 mmHg)
• Dilated LA, LV & MPA
dilated
• Normal PA pressure
• Good Biventricular
Function
Echocardiography
Hb 11.4 gm/dL TC WBC 14 x103/mm3
Serum
Electrolytes
Normal
UrineRME NAD SGPT 10 U/L S. Creatinine 0.68 mg/dL
PT 12.50 sec INR 0.94 APTT 34 sec
BT 2 min 45 sec CT 6 min 15sec Blood Group O+ve
HBsAg Negative VDRL Non reactive Anti HCV Negative
CRP 18 mg/dl RT-PCR for
Covid-19
Negative Blood culture No growth
Other investigations
Confirmatory diagnosis
Moderate size Patient Ductus Arteriosus (PDA) with Pneumonia with
Heart failure with Failure to Thrive.
Management
• Counseling to the parents.
• General supportive & symptomatic management:
• Bed rest.
• Propped up position.
• O2 inhalation.
• Fluid restriction (100 ml/kg)
• Antipyretics
Management contd…..
• Nutritional support:
NG tube feeding,
Multivitamin & mineral supplementation.
• Management of heart failure:
• Inj. Frusemide 6 mg 12 hourly.
• Tab. Enalapril 0.5 mg 12 hourly.
• Digitalization
• Antibiotics:
Inj. Ceftriaxone 500 mg once daily.
Follow up on day 2
Subjective Objective Assessment Plan
Fever persisted
Cough present
Inj. Ceftriaxone
D2
Alert
Dyspnoic
Temp: 100ᵒF
Heart rate :156 b/m,
R/R :55/min
Heart: S1 +S2 + M
Lungs: Creps +
subcostal and intercostal
recession
P/A/E : soft, tender hepatomegaly
Bowel and Bladder - Normal
Static Continue treatment
Follow up on day 4
Subjective Objective Assessment Plan
Afebrile for 1 day
Cough subsided
Inj. Ceftriaxone
D4
Alert
Dyspnoic
Temp: Normal
Heart rate :110 b/m,
R/R :35/min
Heart: S1 +S2 + M
Lungs: Creps +
P/A/E : soft, tender hepatomegaly
Bowel and Bladder - Normal
Improving Continue treatment
Follow up on day 7
Subjective Objective Assessment Plan
Afebrile for 4 days
Inj. Ceftriaxone
D7
Alert
Temp: Normal
Heart rate :110 b/m,
R/R :25/min
Heart: S1 +S2 + M
Lungs: Clear
P/A/E : soft, just palpable liver
Bowel and Bladder - Normal
Improved Prepare for transcatheter
device closure
Specific treatment
• PDA Device closure
PDA Device in Situ
Angiographic Size of
PDA: Aortic End = 7.2
mm, Pulmonary end =
4.5 mm
ADO (10x8 mm) device
was deployed
successfully
Discharge with Advice on
28/06/2021
Plan for next follow up –After
One month for Echocardiography
Case  presentation on PDA
Angiographic evaluation in cath lab
• Assessment of the hemodynamics
• Measurement of aortic and PAP
• Descending aorta angiogram to precisely assess the aortic arch and
PDA characteristics
• Assessment of anatomy of the duct
Case  presentation on PDA
Case  presentation on PDA
Case  presentation on PDA
PDA Device Deployed successfully
Case  presentation on PDA
Case  presentation on PDA
Follow up
• Residual shunt present
• Device position
• Absent LPA stenosis
• Normal pulmonary Artery
pressure

More Related Content

PPT
Pediatric-Cardiology-101.ppt
PPTX
Case presentation of ventricular septal defect VSD 30 4-2019
PPTX
Acynotic congenital heart disease 2021
PPT
Acyanotic chd
DOCX
Case study of TOF
PPTX
Paediatric Congenital Heart Defects Case Presentation
PPT
Asd case dr. bayazid
PPTX
Tetralogy of Fallot long case discussion
Pediatric-Cardiology-101.ppt
Case presentation of ventricular septal defect VSD 30 4-2019
Acynotic congenital heart disease 2021
Acyanotic chd
Case study of TOF
Paediatric Congenital Heart Defects Case Presentation
Asd case dr. bayazid
Tetralogy of Fallot long case discussion

What's hot (20)

PDF
Patent ductus arteriosus A long case presentation
PPTX
Pregnancy Induced Hypertension - Pre eclampsia
DOCX
Anaemia in pregnancy
PPTX
Tetralogy of Fallot - Case Presentation
PPTX
Pediatric case presentation (congenital heart disease- PDA)
PPTX
Inferior myocardial infarction
PPTX
pediatrics case VSD
PPSX
Mitral regurgitation for post graduates
PPTX
Paediatrics instruments
PPT
case presentation
PPT
Hydrocephalus - Case Presentation (2).ppt
PPTX
chronic liver disease
PPTX
Aortic stenosis - case report
PPTX
Asd long case
PPTX
Mitral Stenosis Case presentation
PPTX
Paediatrics - Case presentation: fever+rash
PPTX
Thalassemia Case presentation
PDF
case presentation on neonatal jaundice
PPTX
Case Presentation On Respiratory Medicine
PPTX
Asthma exacerbation case study in pediatrics
Patent ductus arteriosus A long case presentation
Pregnancy Induced Hypertension - Pre eclampsia
Anaemia in pregnancy
Tetralogy of Fallot - Case Presentation
Pediatric case presentation (congenital heart disease- PDA)
Inferior myocardial infarction
pediatrics case VSD
Mitral regurgitation for post graduates
Paediatrics instruments
case presentation
Hydrocephalus - Case Presentation (2).ppt
chronic liver disease
Aortic stenosis - case report
Asd long case
Mitral Stenosis Case presentation
Paediatrics - Case presentation: fever+rash
Thalassemia Case presentation
case presentation on neonatal jaundice
Case Presentation On Respiratory Medicine
Asthma exacerbation case study in pediatrics
Ad

Similar to Case presentation on PDA (20)

PPTX
PPTX
VSD with Pneu Muneebur 19.10.17.pptx.....
PPTX
Bronchiolitis presentation on anwer khan.pptx
PPTX
Congenital ns
PPTX
CASE STUDY
PPTX
Presentation on tetralogy of fallot
PDF
PCAP presentation.pdf
PPTX
case presentation respiratory system.pptx
PPTX
RS CASE.pptx. ............ Mmm.......
PPTX
CPD 2023 FB (1).pptx
PDF
pCAP C Intern's Case Report
PPTX
T Lymphoblastic lymphma.pptx
PPTX
Bronchiolitis -case presentation
PPTX
CM cystic fibrosis.pptx.nice to know this
PPTX
Pediatrics Community Acquired Pneumonia case study.pptx
PPTX
pediatrics Case Presentation for seminar.pptx
PPT
5. PDA
PPTX
Gc1 chd
PPTX
Shifa collapse consolidation
PPTX
Nicu 3 2012 - interdepartment case copy - copy
VSD with Pneu Muneebur 19.10.17.pptx.....
Bronchiolitis presentation on anwer khan.pptx
Congenital ns
CASE STUDY
Presentation on tetralogy of fallot
PCAP presentation.pdf
case presentation respiratory system.pptx
RS CASE.pptx. ............ Mmm.......
CPD 2023 FB (1).pptx
pCAP C Intern's Case Report
T Lymphoblastic lymphma.pptx
Bronchiolitis -case presentation
CM cystic fibrosis.pptx.nice to know this
Pediatrics Community Acquired Pneumonia case study.pptx
pediatrics Case Presentation for seminar.pptx
5. PDA
Gc1 chd
Shifa collapse consolidation
Nicu 3 2012 - interdepartment case copy - copy
Ad

Recently uploaded (20)

PPTX
AI_in_Pharmaceutical_Technology_Presentation.pptx
PPTX
Trichuris trichiura infection
PPTX
First aid in common emergency conditions.pptx
PPT
Recent advances in Diagnosis of Autoimmune Disorders
PDF
MINERAL & VITAMIN CHARTS fggfdtujhfd.pdf
PPT
Parental-Carer-mental-illness-and-Potential-impact-on-Dependant-Children.ppt
PDF
Megan Miller Colona Illinois - Passionate About CrossFit
PPTX
ABG advance Arterial Blood Gases Analysis
PDF
Dr. Jasvant Modi - Passionate About Philanthropy
PPT
KULIAH UG WANITA Prof Endang 121110 (1).ppt
PPTX
General Pharmacology by Nandini Ratne, Nagpur College of Pharmacy, Hingna Roa...
PPTX
Pulmonary Circulation PPT final for easy
PDF
NUTRITION THROUGHOUT THE LIFE CYCLE CHILDHOOD -AGEING
PDF
Structure Composition and Mechanical Properties of Australian O.pdf
PPTX
3. Adherance Complianace.pptx pharmacy pci
PDF
A Brief Introduction About Malke Heiman
PPTX
protein composition & amino acccids.pptx
PPTX
Infection prevention and control for medical students
PPTX
PE and Health 7 Quarter 3 Lesson 1 Day 3,4 and 5.pptx
PDF
Khaled Sary- Trailblazers of Transformation Middle East's 5 Most Inspiring Le...
AI_in_Pharmaceutical_Technology_Presentation.pptx
Trichuris trichiura infection
First aid in common emergency conditions.pptx
Recent advances in Diagnosis of Autoimmune Disorders
MINERAL & VITAMIN CHARTS fggfdtujhfd.pdf
Parental-Carer-mental-illness-and-Potential-impact-on-Dependant-Children.ppt
Megan Miller Colona Illinois - Passionate About CrossFit
ABG advance Arterial Blood Gases Analysis
Dr. Jasvant Modi - Passionate About Philanthropy
KULIAH UG WANITA Prof Endang 121110 (1).ppt
General Pharmacology by Nandini Ratne, Nagpur College of Pharmacy, Hingna Roa...
Pulmonary Circulation PPT final for easy
NUTRITION THROUGHOUT THE LIFE CYCLE CHILDHOOD -AGEING
Structure Composition and Mechanical Properties of Australian O.pdf
3. Adherance Complianace.pptx pharmacy pci
A Brief Introduction About Malke Heiman
protein composition & amino acccids.pptx
Infection prevention and control for medical students
PE and Health 7 Quarter 3 Lesson 1 Day 3,4 and 5.pptx
Khaled Sary- Trailblazers of Transformation Middle East's 5 Most Inspiring Le...

Case presentation on PDA

  • 2. Particulars of the patient Name- Minu Akter Age- 1 year. Sex- Female. Religion- Islam. Address- Moghbazar, Dhaka. Informant- Mother. Date and time of admission- 10/06/2021 Date and time of examination- 11/06/2021
  • 3. Chief complaints • Fever for four days • Cough and cold for 4 days • Breathlessness for 2 days • Not growing well since her early infancy
  • 4. History of present illness • According to the statement of the informant (mother) baby was relatively well four days back then she developed fever, which was low grade intermittent in nature, not associated with chills and rigor, highest recorded temperature was 101ᵒF, Fever subsided after taking antipyretics with little or no sweating. • Mother also complained of cough and running nose for same duration. Cough present throughout day and night, without any particular aggravating and reliving factor. • The baby had breathlessness for last two days, which made her difficulty in feeding, feeding is associated with suck rest and suck cycles.
  • 5. H/O present illness cont…. • This breathlessness has no diurnal, seasonal variation and not related to exposure to cold, dust, pollen, fume etc. • Mother also complained that her baby’s weight is not gaining since her 3-4 moths of age. • There is no history of bluish discoloration of skin, finger nail, toes and lips.
  • 6. History of past illness • She had history of repeated lower respiratory tract infection. Patient required 2 times hospitalization for pneumonia in 3 months apart. She was treated with iv antibiotics, oxygen, nebulization along with other medications.
  • 7. Drug history • Baby has been taking syrup Frusemide and table Spironolactone for last six months as prescribed by the doctor. • Now she is currently on some injectable and syrup which increase the urine output along with multivitamins.
  • 8. Birth history Antenatal- Mother was under regular ante natal checkup and her pregnancy was uneventful. no h/o fever, rash, in mother during antenatal period no h/o drug intake, smoking and alcohol intake no h/o DM, HTN Natal- born by FTNVD/wt 3kg/no h/o NICU admission Postnatal- Baby cried immediately after birth. No h/o cyanosis/prolong jaundice/ petechae /seizure in NB Period
  • 9. Feeding history • Baby received exclusive breast feeding for first six months, then weaning was started with soft rice, suzi, khichuri. Now the baby is on family diet.
  • 10. Immunization history Immunization is upto date according to EPI schedule.
  • 11. Developmental history • Developmentally she is age appropriate.
  • 12. Family history • Baby is the second issue of her non consanguineous parent. Her elder brother and her parents are healthy. • The is no h/o of congenital heart disease in the family.
  • 14. Socioeconomic history • Belongs to a lower socioeconomic condition. Lives in semi paka house, drinks water from tube well. Father is a service holder and mother is housewife.
  • 15. General examination  Appearance- Ill looking.  Body build- Below Average.  Decubitus- On choice.  Anemia- Absent.  Jaundice- Absent.  Cyanosis-Absent.  Koilonychias- Absent.  Leuconychia- Absent.  Clubbing- Absent.  Edema- Absent.  Dehydration- Absent.  Thyroid- Not enlarged.  Lymph node- Not palpable.  JVP-Not raised.
  • 16. vitals • Pulse Rate- 160/min, regular, high volume, no radio radial and radiofemoral delay • RR- 55/min • Temp-101ᵒF • BP-90/40 mm of Hg. • Spo2- 98% in room air
  • 17. Anthropometric measurement Height – 71 cm. Weight – 7.2 kg. • Weight for age Z-Score : -2.94 • Weight for length Z-Score : -2.28 • Height for age Z-Score: -2.1 Occiput frontal circumference (OFC) – 44 cm (5th centile) Mid upper arm circumference (MUAC) – 12.5 cm.
  • 18. Cardiovascular system examination Inspection: Precordium is normal in size and shape visible apex beat present No scar mark, no venous engorgement Palpation: Apex beat is situated left fifth intercostal space just lateral to mid clavicular line. Thrusting in nature Thrill – Systolic thrill present in the upper left sternal border. Left parasternal heave – absent. No palpable P2 Auscultation: heart rate-160/min, rhythm regular 1st and 2nd heart sound is inconspicuous, There is harsh continuous machinery murmur at upper left sternal edge with systolic accentuation. Grade 4/6, which radiate to left infraclavicular area
  • 19. Respiratory system examination Inspection: • Shape and size of the chest is normal. • Fast breathing with respiratory rate 56 breaths/min. • Subcostal and Intercostal recession – Present. Palpation: • Trachea centrally placed. • Apex beat in left fifth intercostal space just lateral to MCL Percussion: Bilaterally resonant Auscultation: Vesicular breath sound Crepitation present in both lungs field more marked in medial and lower zones
  • 20. Alimentary system Inspection: • Oral cavity normal in appearance, tongue is moist, tonsil show no signs of inflammation • Abdomen normal in shape and size. Umbilicus centrally placed and inverted. No scar mark. No venous engorgement. Palpation: abdomen is soft, nontender and liver is enlarged, 3 cm from rt costal margin, surface smooth, soft in consistency, upper border of liver dullness on rt 5th intercostal space. Percussion: tympanic, no ascites Auscultation: Bowel sound present
  • 21. Salient features Minu Akter, 1 year old female baby hailing from Moghbazar, Dhaka, came with complaints of Fever for 4 days, which was low grade intermittent in nature and subsided by taking antipyretics. Mother also complaints of cough, running nose for four days and breathlessness for last 2 days which made her difficulty in feeding, her feeding is associated with suck rest and suck cycles. She has recurrent history of RTI. There is no history of bluish discoloration of skin, finger nail, toes and lips. On examination baby is ill looking, febrile, dyspnoic, and tachypnea and tachycardia is present, She is acyanotic, non edematous. Baby is moderately wasted and stunted.
  • 22. Salient features contd…. High volume pulse with wide pulse pressure present. Apex beat is situated left fifth intercostal space just lateral to mid clavicular line which is thrusting in nature . Systolic thrill present on the left upper sternal edge. 1st and 2nd heart sound is inconspicuous, there is a continuous machinery murmur best heard at upper left sternal edge, Grade 4/6, which radiate to left infraclavicular area. Intercostal and subcostal recession present. Breath sound is vesicular with crepitation present in middle and lower zone of both lung field, There is hepatomegaly. Other systemic examination revealed normal findings .With these complaints he has been admitted to BSMMU for further management.
  • 23. Provisional diagnosis • Acyanotic congenital heart disease most probably Patent Ductus Arteriosus (PDA) with heart failure with Pneumonia with FTT.
  • 24. Points in favour PDA Heart failure Pneumonia Acyanotic Tachycardia Fever High volume pulse with wide pulse pressure Tachypnea Dyspnea Thrusting apex beat Enlarge tender liver Intercostal and subcostal recession Continuous machinery murmur Cardiomegaly Crepitation Bilateral basal crepitation
  • 25. Differential diagnosis DD Points in favors Points against Aortopulmonary window Clinical presentation are similar to PDA Bounding peripheral pulse, wide pulse pressure • More in Male • Continuous murmur is more pronounce on the left 3rd intercostal space Venous hum Continuous murmur Best heard in infraclavicuar area • Pt is clinically normal • It is audible only in upright position • Disappear in supine position • It is best heard on the right side • It is also change with position of neck Rupture sinus of valsulva Features of heart failure Continuous murmur Sudden onset chest pain, with dyspnea,
  • 27. ECG
  • 28. Echocardiography • A moderate sized PDA (4 mm) with L-R shunt (PPG 73 mmHg) • Dilated LA, LV & MPA dilated • Normal PA pressure • Good Biventricular Function
  • 30. Hb 11.4 gm/dL TC WBC 14 x103/mm3 Serum Electrolytes Normal UrineRME NAD SGPT 10 U/L S. Creatinine 0.68 mg/dL PT 12.50 sec INR 0.94 APTT 34 sec BT 2 min 45 sec CT 6 min 15sec Blood Group O+ve HBsAg Negative VDRL Non reactive Anti HCV Negative CRP 18 mg/dl RT-PCR for Covid-19 Negative Blood culture No growth Other investigations
  • 31. Confirmatory diagnosis Moderate size Patient Ductus Arteriosus (PDA) with Pneumonia with Heart failure with Failure to Thrive.
  • 32. Management • Counseling to the parents. • General supportive & symptomatic management: • Bed rest. • Propped up position. • O2 inhalation. • Fluid restriction (100 ml/kg) • Antipyretics
  • 33. Management contd….. • Nutritional support: NG tube feeding, Multivitamin & mineral supplementation. • Management of heart failure: • Inj. Frusemide 6 mg 12 hourly. • Tab. Enalapril 0.5 mg 12 hourly. • Digitalization • Antibiotics: Inj. Ceftriaxone 500 mg once daily.
  • 34. Follow up on day 2 Subjective Objective Assessment Plan Fever persisted Cough present Inj. Ceftriaxone D2 Alert Dyspnoic Temp: 100ᵒF Heart rate :156 b/m, R/R :55/min Heart: S1 +S2 + M Lungs: Creps + subcostal and intercostal recession P/A/E : soft, tender hepatomegaly Bowel and Bladder - Normal Static Continue treatment
  • 35. Follow up on day 4 Subjective Objective Assessment Plan Afebrile for 1 day Cough subsided Inj. Ceftriaxone D4 Alert Dyspnoic Temp: Normal Heart rate :110 b/m, R/R :35/min Heart: S1 +S2 + M Lungs: Creps + P/A/E : soft, tender hepatomegaly Bowel and Bladder - Normal Improving Continue treatment
  • 36. Follow up on day 7 Subjective Objective Assessment Plan Afebrile for 4 days Inj. Ceftriaxone D7 Alert Temp: Normal Heart rate :110 b/m, R/R :25/min Heart: S1 +S2 + M Lungs: Clear P/A/E : soft, just palpable liver Bowel and Bladder - Normal Improved Prepare for transcatheter device closure
  • 37. Specific treatment • PDA Device closure
  • 38. PDA Device in Situ Angiographic Size of PDA: Aortic End = 7.2 mm, Pulmonary end = 4.5 mm ADO (10x8 mm) device was deployed successfully
  • 39. Discharge with Advice on 28/06/2021 Plan for next follow up –After One month for Echocardiography
  • 41. Angiographic evaluation in cath lab • Assessment of the hemodynamics • Measurement of aortic and PAP • Descending aorta angiogram to precisely assess the aortic arch and PDA characteristics • Assessment of anatomy of the duct
  • 45. PDA Device Deployed successfully
  • 48. Follow up • Residual shunt present • Device position • Absent LPA stenosis • Normal pulmonary Artery pressure