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

VIII. Radiology

  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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Ontology: Patent ductus arteriosus (C0013274)

Definition (NCI) A congenital defect characterized by the failure of the ductus arteriosus to close soon after birth. As a consequence, blood from the aorta mixes with blood from the pulmonary artery. If untreated, it may lead to congestive heart failure.
Definition (CSP) abnormal persistence of an open lumen in the ductus arteriosus after birth, the direction of flow being from the aorta to the pulmonary artery, resulting in recirculation of arterial blood through the lungs.
Definition (MSH) A congenital heart defect characterized by the persistent opening of fetal DUCTUS ARTERIOSUS that connects the PULMONARY ARTERY to the descending aorta (AORTA, DESCENDING) allowing unoxygenated blood to bypass the lung and flow to the PLACENTA. Normally, the ductus is closed shortly after birth.
Concepts Congenital Abnormality (T019)
MSH D004374
ICD9 747.0
ICD10 Q25.0
SnomedCT 83330001, 156928009
English Ductus Arteriosus, Patent, Patent ductus - persist type, Patent ductus arteriosus - persisting type, Patent ductus arteriosus, PDA, PDA1, PATENT DUCTUS ARTERIOSUS, patent ductus arteriosus (diagnosis), patent ductus arteriosus, PDA (patent ductus arteriosus), Ductus arteriosus patent, Persistent ductus arteriosus, Ductus Arteriosus, Patent [Disease/Finding], Patency of the Ductus Arteriosus, arteriosus ductus patent, ductus arteriosus persistent, patent arteriosus ductus, patent ductus arteriosis, arteriosis ductus patent, persistent ductus arteriosus, Patent ductus arteriosis, Patent Ductus Arteriosus, Patent ductus Botalli, PDA - Patent ductus arteriosus, Patent arterial duct, Patent ductus arteriosus (disorder), d.arteriosus; nonclosure, d.arteriosus; open, d.arteriosus; persistent, nonclosure; ductus arteriosus, open; ductus arteriosus (Botalli), persistent; ductus arteriosus (Botalli)
Dutch PDA, d.arteriosus; niet sluiten, d.arteriosus; open, d.arteriosus; persisterend, niet sluiten; ductus arteriosus, open; ductus arteriosus (Botalli), persisterend; ductus arteriosus (Botalli), open ductus arteriosus, Ductus arteriosus, open, Open ductus arteriosus
French Voie artérielle perméable, Pers du canal art, Canal artériel perméable, PERSISTANCE DU CANAL ARTERIEL, Persistance du canal artériel, Canal artériel, Canal artériel persistant, PCA (Persistance du Canal Artériel ), Perméabilité du canal artériel, Perméabilité du canal de Botal
German Ductus arteriosus offen, PDA, DUKTUS ARTERIOSUS OFFEN, Offener Ductus arteriosus, offener Ductus arteriosus, Ductus arteriosus, offener, Ductus Botalli persistens
Portuguese Canal arterial persistente, PERSISTENCIA DO CANAL ARTERIAL, Permeabilidade do Canal Arterial, Canal Arterial Persistente, Persistência do Canal Arterial, Persistência do canal arterial
Spanish DAP, DUCTUS ARTERIOSO, PERSISTENCIA, Conducto Arterioso Permeable, Conducto Arterioso Persistente, Persistencia del Conducto Arterioso, conducto arterioso persistente (trastorno), conducto arterioso persistente, ductus arteriosus persistente, Conducto arterioso persistente, conducto arterioso de Botal, conducto arterioso de Botal persistente
Japanese 動脈管開存症, PDA, PDA, ドウミャクカンカイゾンショウ
Swedish Ductus arteriosus, öppetstående
Czech ductus botalli apertus, Otevřený ductus arteriosus, Otevřený ductus arteriosus (Botalli), otevřená Botallova dučej, ductus arteriosus patens, otevřená tepenná dučej
Finnish Avoin valtimotiehyt
Russian ARTERIAL'NOGO PROTOKA NEZARASHCHENIE, BOTALLOVA PROTOKA NEZARASHCHENIE, АРТЕРИАЛЬНОГО ПРОТОКА НЕЗАРАЩЕНИЕ, БОТАЛЛОВА ПРОТОКА НЕЗАРАЩЕНИЕ
Korean 동맥관개방
Croatian DUCTUS ARTERIOSUS, OTVORENI
Polish Przetrwały przewód Botalla, Przewód tętniczy przetrwały
Hungarian Nyitott ductus arteriosis, Nyitott ductus arteriosus, Ductus arteriosus nyitott, Pda
Norwegian Persisterende ductus arteriosus, Ductus Botalli persistens, Ductus arteriosus persistens, Patent ductus arteriosus, Åpentstående ductus arteriosus
Italian Dotto arterioso pervio