Duct dependant pulmonary perfusion

[drakjaleel]

I have a neonate with critical cyanotic heart disease on prostaglandin infusion

after that perfusion improved

Now the kid is hemodynamically stable

Cardiac CT confirms Pulmonary Atresia and double PDA supplying lungs

Shall we stop infusion?

What are all options available for the baby survival?

[drumartak]

Pulmonary atresia is with VSD or without ? Its a wide spectrum of disease so needs to do detailed echo and cath to know about PDA and major aorta-pulmonary shunts etc. also important to know about family history and any dysmorphism.

Coming back to your question -- prostaglandin must be continued until case is taken over by cardiology team and then they do palliative or complete repair. Palliative repair depends on kind of anatomy. If its a just atresia then could be perforated with cath and then ballon ... Else modified BT shunt.

Your baby responded to prostaglandin so very likely it is a duct dependent and not enough collaterals yet. So please do continue prostaglandin.

Survival again depends on complexity of anatomy and expert surgical facilities available.

Thanks for sharing your case and best wishes.

Dr Umar

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[Stefan Johansson]

The baby will need fill its pulmonary circulation through some variant of shunt. Unless the ducts remains open (providing that shunt), a Blalock–Taussig shunt could be an option.

 

Suggests consultation with a pediatric cardiologist and ped cardiac surgeon on the management.

[drakjaleel]

For the baby with bilateral PDA ,stent placed successfully

[drakjaleel]

Thanks for the input

Kid hemodynamically stable

[Francesco Cardona]

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All Things Neonatal are you sure these are double PDAs and not MAPCAs? Would need to rule out the presence of other MAPCAs before deciding on whether prostin needs to be continued or not.