(英文原文)Two algorithms are provided for the management of patent ductus arteriosus. For the first, "Time 0" is the initial evaluation by a pediatric cardiologist and the patient is less than 6 months old, and for the second the patient is 6 months old or older at the time of that evaluation. The algorithms provide for an initial history, physical examination, electrocardiogram, and echocardiogram. In patients with a patent ductus arteriosus that has been documented echocardiographically, surgical closure of the defect can be done without additional echocardiographic studies if the physical findings remain typical for an uncomplicated patent ductus arteriosus. If the findings become atypical, one additional echocardiographic study is considered necessary. The algorithm provides for elective closure of the patent ductus arteriosus sometime within the first year of life.
After surgery, successful ligation/division of the ductus arteriosus can be documented by physical examination. The algorithm provides for a posthospital outpatient evaluation, usually within 3 months of surgery. A chest radiogram may be necessary to exclude persistent perioperative problems. Echocardiography to confirm ductal closure is a class II test and is intended to demonstrate complete closure of the patent ductus arteriosus. It is recognized that additional postoperative studies may be needed for treatment of individual patients in the perioperative period. The evaluation provides for detection of additional perioperative problems such as wound infection, pleural effusion, etc. After documentation of successful ligation/division of the ductus arteriosus and resolution of all perioperative problems, further cardiac evaluation is unnecessary.
The algorithm for patent ductus arteriosus in patients older than 6 months differs from that for patients younger than 6 months only in that surgical closure can be performed shortly after diagnosis.
Copyright © 2017 - All Rights Reserved - CHD KB |