Monitoring
With the increased use of echocardiography, incidental detection of asymptomatic patent ductus arteriosus (PDA) is increasing, leading towards a wide variation in the timing of follow-up and recommended testing in patients with PDA. Generally, patients with a PDA are followed by a pediatric cardiologist with serial echocardiograms. In infants this is often done fairly regularly at 3-month intervals. In older children, follow-up is less frequent (and often closure is scheduled before a follow-up visit). After closure, most patients are seen for follow-up at 1 month, and again between 6 months to 1 year. Most institutions will then discharge patients unless there is a residual lesion. Because long-term experience with catheter closure is more limited than with surgical ligation, some practitioners will continue to follow up these patients every 2 years. In patients with isolated PDA without extracardiac comorbidities, a less conservative approach has been suggested. The American College of Cardiology recommends that patients with trivial or “silent” isolated PDA be discharged from cardiology care without requiring proof of closure. Patients with small PDAs may be monitored infrequently in clinic (every 2-3 years) for development of left heart dilation. Patients who have had surgical closure of PDA, and have no clinical concerns, can be discharged from cardiology follow-up after a suitable interval.[127]
The management of developmental delays in children with PDA should include early referrals to developmental specialists and targeted interventions, such as physical, occupational, and speech therapies, alongside early educational support to address specific developmental needs.[11]
Premature infants will need to be observed for a longer period as the ductus may reopen in some patients. However, they are often followed clinically by their primary physician or neonatal specialist.
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