patent ductus arteriosus
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Introduction
Congenital anomaly resulting from failure of the ductus arteriosus to close after birth.
Etiology
* also see Eisenmenger's syndrome
Pathology
- arteriovenous fistula
- small ductus compatible with normal life span
- ductus may calcify in adult life
- large patent ductus arteriosus may cause significant left-to-right shunt, with left sided cardiac chamber enlargement & result heart failure
- may produce elevated pulmonary pressure
- patent ductus arteriosus with severe pulmonary hypertension is Eisenmenger's syndrome*
* Eisenmenger's syndrome is severe pulmonary hypertension associated with left-to-right shunt (patent ductus arteriosus, ventricular septal defect or atrial septal defect)
Clinical manifestations
- may be asymptomatic
- retarded growth
- exertional dyspnea
- heart murmur spanning the entire cardiac cycle
- machinery-like (machine-like) in quality
- late systolic accentuation
- loudest in the 2nd intercostal space beneath left clavicle
- S2 may be inaudible
- collapsing pulse (large shunt)
- high pulse pressure (large shunt)
- adults may present with:
- cyanosis & clubbing of feet > hands
- heart failure[3]
Diagnostic procedures
- electrocardiogram
- normal with small PDA
- left atrial enlargement, left ventricular hypertrophy
- right ventricular hypertrophy with pulmonary hypertension
- angiography determines morphology & feasibility of percutaneous surgical closure[3]
Radiology
- chest X-ray
- normal with small PDA
- with large PDA
- cardiomegaly, increased pulmonary vasculature
- calcified PDA
- with pulmonary hypertension
- prominent central pulmonary arteries
- reduced peripheral pulmonary vascular markings
- pulmonary artery opacification on aortogram
- echocardiogram
Complications
- endocarditis [3]
- right heart failure, pulmonary hypertension, Eisenmenger's syndome with large PDA
Management
- size determines management: a tiny PDA requires not intervention[3]
- surgery is curative
- indications
- surgical closure may result in clinical deterioration[3]
- medical therapy for pulmonary hypertension if patient is not a candidate for surgery
- endocarditis prophylaxis not needed after surgery
More general terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 46
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 880
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
- ↑ Silversides CK, Dore A, Poirier N et al Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: shunt lesions. Can J Cardiol. 2010 Mar;26(3):e70-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20352137