Patent Duct Arteriosus
N C Joshi
Consultant Pediatrician, Nanavati Hospital, Mumbai, India
First Created: 01/16/2001 

Introduction

It is a common problem in premature infants.

Patent Duct Arteriosus - Clinical Manifestations

  • Asymptomatic with small shunts

  • CHF with large shunts

  • Differential cyanosis (If PVOD develops)

Physical Examination:

  • Systolic ejection murmur: only evidence in newborn

  • continuous (machinery) murmur develops later

  • Bounding peripheral pulses

Figure 1: Cardiac findings of patent ductus arteriosus. A systolic thrill may be present in the area shown by dots.


Cardiac findings of patent ductus arteriosus

Investigations

ECG:

  • Normal in small VSD

  • LAE, LVH in moderate VSD

  • LAE, BVH in large VSD

  • RVH in Pulmonary vascular obstructive disease (PVOD)

Chest x-ray:

  • Heart size: enlarged

  • PV: increased

Patent Duct Arteriosus - Differential Diagnosis

  • Coronary AV fistula

  • Pulmonary AV fistula

  • Venous hum

  • Collateral murmur (TOF)

  • VSD with AI

  • Absent pulmonary valve

  • Truncus arteriosus

  • A-P window

  • PPS

Treatment

Medical

  • anticongestive measures

  • Indomethacin

Surgical

  • Indicated if asymptomatic (after 1 year of age)

  • If symptomatic - any age

Complications of Surgery

  • Injury to recurrent laryngeal nerve

  • Injury to left phrenic nerve

  • Re-opening of the ducts


Patent Duct Arteriosus Patent Duct Arteriosus 01/16/2001
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