Patent Duct Arteriosus

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.

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