Patient discussions
Patients previously required infective endocarditis prophylaxis for dental procedures. However, US and European guidelines no longer recommend prophylaxis for dental procedures for patients with patent ductus arteriosus (PDA) because of the small numbers of cases of infective endocarditis felt to be prevented by antibiotic use.[82][120] In contrast, after catheter closure with a device, patients should observe infective endocarditis prophylaxis for 6 months until the device is endothelialised. Additionally, patients will need to continue to observe infective endocarditis prophylaxis if there is a residual shunt near the device.[82]
Patients with an untreated small PDA with normal left chamber size can participate in all levels of competitive sport. Those with a more significant shunt and left heart enlargement should undergo definitive closure prior to partaking in competitive athletics. They may return to full participation 3 months after closure if they have a normal cardiac examination without evidence of left ventricular enlargement or elevated pulmonary pressures. If patients demonstrate elevated pulmonary resistance (pulmonary pressures >30 mmHg), individual recommendations for levels of physical activity must be undertaken.[121]
As patients transition from adolescent to adult care, it is important to provide education on self-management and to help them build their medical knowledge. It is important, for example, to ensure that they are equipped with the skills needed to make medical appointments and refill prescriptions, and that they understand the importance of lifestyle interventions such as weight management and non-smoking.[122]
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