Patent Ductus Arteriosus

  • Brynn Connor
  • Victoria Eng
  • Meghan C. Kusko
  • Kathryn Maselli

Abstract

Patent ductus arteriosus (PDA) is a congenital heart defect where the ductus arteriosus maintains a shunt between the left pulmonary artery and the aorta. Clinical presentation and findings on cardiac auscultation vary depending on the size of the shunt. Classically, PDA presents with a continuous crescendo-decrescendo murmur described as “machinery-like”. To determine the degree of shunting through the PDA, Doppler echocardiography may be employed. Patients with a large PDA are at risk for persistent elevation in pulmonary vascular resistance thereby precipitating Eisenmenger’s syndrome. In this syndrome, shunting is ultimately reversed and patients experience subsequent cyanosis and/or pulmonary hypertension. The decision to treat a PDA should be based upon a combination of clinical signs and echocardiographic parameters. Treatment options include pharmacological closure in infants, catheterization, and surgical ligation.

Keywords

Patent ductus arteriosus Auscultation Definition Diagnosis Eisenmenger’s Classification Treatment Prognosis 

Supplementary material

310603_1_En_26_MOESM1_ESM.mp4 (955 kb)
Video 26.1 PDA with a long diastolic component, which makes the murmur truly continuous (Provided by Robin Winkler Doroshow, MD, Medstar Georgetown University Hospital, Washington, DC) (MP4 954 kb)
310603_1_En_26_MOESM2_ESM.mp4 (1.3 mb)
Video 26.2 PDA with a short diastolic component that is more typical (Provided by Robin Winkler Doroshow, MD, Medstar Georgetown University Hospital, Washington, DC) (MP4 1354 kb)

References

  1. 1.
    Evans N. Current controversies in the diagnosis and treatment of patent ductus arteriosus in preterm infants. Adv Neonatal Care. 2003;3:168–77.CrossRefPubMedGoogle Scholar
  2. 2.
    Gournay V. The ductus arteriosus: physiology, regulation, functional, and congenital anomalies. Arc Card Dis. 2011;104:578–85.CrossRefGoogle Scholar
  3. 3.
    Akhfash AA, Almsnid A, Hasson M, Alharbi B, AlGhamdi A. Echocardiographic predictors of coarctation of the aorta. J Saudi Heart Assoc. 2012;24:273.CrossRefGoogle Scholar
  4. 4.
    Lu C, Wang J, Chang C, et al. Noninvasive diagnosis of aortic coarctation in neonates with patent ductus arteriosus. J Pediatr. 2006;148:217–21.CrossRefPubMedGoogle Scholar
  5. 5.
    Hollinger DL, Moskowitz D. Congenital heart disease. In: Troianos C, editor. Anesthesia for the cardiac patient. St. Louis: Elsevier Press; 2002. p. 287–316.Google Scholar
  6. 6.
    Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, Libby P, editors. Braunwald’s heart disease: a textbook of cardiovascular medicine. 9th ed. Philadelphia: Saunders Elsevier; 2011. chap 65.Google Scholar
  7. 7.
    Schneider DJ, Moore JW. Congenital heart disease for the adult cardiologist. Circulation. 2006;114:1873–82.CrossRefPubMedGoogle Scholar
  8. 8.
    Stark J, Hjordtal V. Persistent ductus arteriosus (Trans. Array surgery for congenital heart defects, 3rd ed). Stark JF, de Leval MR, Tsang VT, editors. Chichester: John Wiley & Sons; 2006: 275–82.Google Scholar
  9. 9.
    Chiruvolu A, Punjwani P, Ramaciotti C. Clinical and echocardiographic diagnosis of patent ductus arteriosus in premature neonates. Early Hum Dev. 2009;85:147–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Chorne N, Leonard C, Piecuch R, Clyman R. PDA and its treatment as risk factors for neonatal and neurodevelopmental morbidity. Pediatrics. 2007;119:1165–74.CrossRefPubMedGoogle Scholar
  11. 11.
    Anoop TM, George KC. Differential clubbing and cyanosis. N Engl J Med. 2011;364:666.CrossRefPubMedGoogle Scholar
  12. 12.
    Diller GP, Dimopoulos K, Broberg CS, Mehmet GK, Naghotra US, Uebing A, Harries C, Goketin O, Simon J, Gibbs R, Garzoulis MA. Presentation, survival prospects, and predictors of death in Eisenmenger syndrome: a combined retrospective and case–control study. Eur Heart J. 2006;27:1737–42.CrossRefPubMedGoogle Scholar
  13. 13.
    Diller GP, Gatzoulis MA. Pulmonary vascular disease in adults with congenital heart disease. Circulation. 2007;115:1039–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Yan C, Zhao S, Xu Z, Huang L, Zheng H, Ling J, Wang C, Wu W, Hu H, Zhang G, Ye Z, Wang H. Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults. Heart. 2007;93:514–8.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Marquis RM, Miller HC, McCormack RJM, Matthews MB, Kitchin AH. Persistence of ductus arteriosus with left to right shunt in the older patient. Br Heart J. 1982;48:469–84.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Krichenko A, Benson LN, Burrows P, Moes CA, McLaughlin P, Freedon RM. Angiographic classification of the isolated, persistently patent ductus arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol. 1989;63:877–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Moccetti F, Kaufman BA, Tobler D. Differential clubbing and cyanosis: a pathognomonic finding in cardiology. Eur Heart J. 2014;35(21):1410.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  • Brynn Connor
    • 1
  • Victoria Eng
    • 1
  • Meghan C. Kusko
    • 1
  • Kathryn Maselli
    • 1
  1. 1.Georgetown University School of Medicine, Georgetown University HospitalWashingtonUSA

Personalised recommendations