Patent Ductus Arteriosus

Aka: Patent Ductus Arteriosus

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II. Epidemiology

  1. Incidence: 12% of Congenital Heart Defects
  2. Affects 20-60% of Premature Infants
  3. Females affected twice as often as males

III. Risk Factors

  1. Maternal residence at high altitude
  2. Rubella exposure in the first timester

IV. Pathophysiology

  1. Failure after birth of obliteration ductus arteriosus
  2. Leaves communication between aorta and pulmonary artery

V. Symptoms (may be asymptomatic)

  1. Growth retarded
  2. Exertional Dyspnea

VI. Signs

  1. Machinery murmur throughout Cardiac Cycle
  2. Late systolic accentuation of murmur
    1. Left second interspace
    2. Left back
  3. Large shunt related findings
    1. Collapsing Pulse
    2. High Pulse Pressure

VII. Diagnostics: Electrocardiogram

  1. Large PDA
    1. Left Ventricular Hypertrophy
  2. Pulmonary Hypertension
    1. Right Ventricular Hypertrophy
    2. Biventricular hypertrophy

VIII. Imaging

  1. Chest XRay
    1. Cardiomegaly
    2. Increased pulmonary markings
  2. Echocardiogram
    1. Identify PDA on doppler flow
  3. Aortogram
    1. Accentuated pulmonary conus
    2. Prominent pulsating lung markings
    3. Pulmonary artery opacification

IX. Management

  1. Premature Infant (requires urgent management)
    1. Indomethacin
    2. Surgical ligation or transvenous Occlusion
  2. Child
    1. Surgical ligation or transvenous Occlusion

X. References

  1. Saenz (1999) Am Fam Physician 59(7):1857-66 [PubMed]
  2. Cyran (1998) PREP review lecture, October, Phoenix
  3. Merenstein (1994) Pediatrics, Lange

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