clinical-update

Successful Management of a Case Of Large PDA with Congestive Heart Failure & Multi Organ Dysfunction

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Treatment Given

ICU care, High End Antibiotics, PDA ligation, Diuretics, Blood and Blood Products Transfusion, Ventilator Support and other supportive measures.

Hospitalization

Date of admission: 27 March 2019
Date of Operation: 9 April 2019
Date of Discharge: 27 April 2019

Case Summary

Master Rohit Dhoundiyal 14 Months male child was brought in the Pediatrics department on 27/3/19 with complaints of fever and difficulty in breathing. He was referred to SRMSIMS from other hospitals in a critical condition. Through evolution and relevant investigation were done. The child was diagnosed to be suffering from Down’s syndrome with Acyanotic congenital heart Disease (Large PDA) with Congestive heart failure, Pneumonia, Sepsis, DIC and Acute Kidney Injury.

Patient was initially managed with conservative supportive treatment but as the patient was not maintaining adequate oxygen saturation and was in severe distress, patient was put on ventilator support, high-end antibiotics were used to treat sepsis, diuretics were given for CHF, and DIC was treated with repeated FFP transfusion. 2D Echo had revealed a large PDA with left to right shunt, therefore, surgical intervention was planned for the closure of PDA after medical stabilization. But even after improvement in AKI and blood parameters, the child continued to have congestive heart failure & Pneumonia requiring high ventilator settings so the decision was taken to ligate PDA despite the patient in a critical state and high ventilator settings.

Ligation of PDA was done through left postero – lateral thoractomy in 4th intercostal space. After PDA ligation, the condition of the child started improving gradually and was weaned off from ventilator in 5 days. The patient required prolonged antibiotics and diuretics and his condition normalized after 10 days. Postoperative repeat 2D ECHO was done and there was no residual left shunt and his cardiomegaly also decreased. Patient was discharged 1 month after admission in a stable condition.

Patient’s treatment required multidisciplinary approach with a team comprising of Pediatrician, Cardiac Surgeon, Cardiologist and anesthetists.

Dr Vikas Deep Goyal – 9458702319 | Dr Atul Kumar – 9458701770