Patent Ductus Arteriosus (PDA)

pediatric patent ductus arteriosus

Dr. Mariangela Marchesini presents the case of a boy of 5 with patent ductus arteriosus. His fear of dogs, of the dark, slow dentition, desire for soft cooked eggs and perspiration in sleep in the cervical region were among the symptoms that led to the simillimum.

INTRODUCTION

Before a baby is born, the fetus’ blood does not need to go to the lungs to get oxygenated. The ductus arteriosus is a hole that allows the blood to skip the circulation to the lungs. However, when the baby is born, the blood must receive oxygen in the lungs and this hole is supposed to close. If the ductus arteriosus is still open (or patent) the blood may skip this necessary step of circulation. The open hole is called the patent ductus arteriosus.If the ductus remains patent when pulmonary vascular resistance falls, aortic blood is then shunted left to right into the pulmonary artery.A PDA persisting beyond the first few weeks of life in a term infant rarely closes spontaneously or with pharmacologic intervention whereas in a premature infant spontaneous closure occurs in most instances.

PROGNOSIS AND COMPLICATIONS

Spontaneous closure after infancy is extremely rare (1). Patients with a small PDA may live a normal span with few or no cardiac symptoms, but late manifestations may occur.In patients with a large PDA cardiac failure most often occurs in early infancy, but may occur later in life, even with a moderate-sized communication.

TREATMENT

Regardless of age, patients with PDA require catheter or surgical closure.

In patients with a small PDA the rationale for closure is prevention of bacterial endarteritis or other late complications.In patients with moderate to large PDA, closure is accomplished to treat heart failure or prevent the development of pulmonary vascular disease, or both.Once the diagnosis of a moderate to large PDA is made, treatment should not be unduly postponed after adequate medical therapy for cardiac failure has been instituted.

CASE

A 5 year old boy, presented for consultation. He was thin, tall and of healthy complexion, weighing 21.5 kg with height 125 CM, BP 93/58 mmHg and heart rate 73 beats/min.The boy was sent for consultation to the Cardiology Department of Pediatric Clinic Padua Universityfor a systolic murmur 1-2/6 on the left sternal border and a wide splitting of the 2nd heart sound.After investigations he was diagnosed with PDA. (Padova 10 febbraio 2012).  After collective discussion, the Cardiology Team suggested transcatheter PDA closure.

MEDICAL HISTORY

There was no congenital cardiovascular pathology in the family.The boy was born healthy, at term, his growth and development are within normal range, vaccinations have been done. During his first years he was only affected with mild seasonal colds, sometimes with fever up to 39° C. twice a year.

HOMEOPATHIC CONSULTATION (Jul 15, 2013)

Symptoms at the first consultation

The boy is  cheerful, happy and sympathetic (2), shy(2) afraid to be alone (1), afraid of the dark (2), afraid of the dog(1). Dentition slow, first tooth at 10 months age. Hearing impaired from catarrh of eustachian tube for nose discharge problems. Desire for soft cooked eggs (3), sweet (2), cheese(2), cold drinks (2). Perspiration in sleep in cervical region (2). Brittle nails (1). Normal stool. Sleep position on abdomen(2). Enuresis (2).

Analysis:

The boy seems to belong to the 3rd level of the first group of health for the high fever (twice/year) and for the clear symptoms, despite the heart disease, but without particular problems.The remedy is clear, Calcarea Carbonica. The potency given was 200CH, 1 dose every 10 days for 3 months.

Dec 24, 2013- first follow up: clear amelioration of hearing, no more nose dicharge. No change in his enuresis and in the other symptoms. One flu episode with high fever without particular symptoms. Calc-c. 1000CH 1 dose/month for 3 months

Jun 2, 2014 –second follow up: the boy is doing well. Also enuresis ameliorates, sometimes he wets his bed, not afraid of dark and to be alone anymore(1). No more hearing problems.Cardiologist check in May 5, 2014 PDA smaller with persistent left-to-right shunt.Calc-c. 1000CH 1 dose a month for 3 months

May 18, 2015- third follow up: the boy is doing well. The enuresis stopped. No hearing problems.A clever boy who does well wherever he goes, school and sports.

No remedy.

Jun 28, 2016- fourth follow up: he is still doing well. One flu episode in winter time with high fever, cured in few days without complications with Belladonna 1000CH 1 dose.

The last cardiologist examination in June 2016 showed a normal clinical picture, BP 95/60 mmHg , Heart rate 72 beats/min, 1st and 2nd heart sounds regular, no murmurs.The ECG was normal and the Echocardiography demonstrated the closure of the PDA.No more cardiologist follow ups are indicated. No restraint for sporting activities.

CONCLUSION

We have not offered you this case for being a difficult one in homeopathic management- this patient was treated with only one remedy which was his simillimum.  This case just shows the power of classical homeopathy when it is properly applied.This case was simple, because it was at Group A, with symptoms belonging to a clear remedy- even if the congenital malformation indicated surgical therapy as the only possible solution. Group A refers to the organism’s overall ability to react to stimuli, positive or negative, and to remedy it. Today the boy is 10 years old.  He is a happy boy, good at school, who plays tennis and attends cello classes at the conservatory.

BIBLIOGRAPHY

1 D. BERNSTEIN- NELSON  TEXTBOOK OF PEDIATRICS 20 EDITION

Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/Patent-Ductus-Arteriosus-PDA_UCM_307032_Article.American Hearth Association Jan 19, 2018

3 G. VITHOULKAS- LEVELS OF HEALTH- Revised Edition- IACH ALONISSOS 2017

4 G. VITHOULKAS- MATERIA MEDICA VIVA- IACH 1997

About the author

Mariangela Marchesini

Mariangela Marchesini

Dr. Mariangela Marchesini MD, graduated in Medicine and Surgery at the University of Padua and specialized at the same University in Pediatrics. She lives and works as a pediatrician and homeopathic doctor in Vicenza Italy. She trained at the International Academy of Classical Homeopathy since 2000. In 2004 she graduated in Classical Homeophaty at IACH. She has been working on setting up and running the E-Learning training program of the Academy translating the subtitles into the Italian language. She is also the tutor of the E-Learning course for Italian Students.

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