Patent Ductus Arteriosus
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Introduction
Patent ductus arteriosus is a congenital heart problem whereby the normal vessel connecting the fetal pulmonary artery and aorta remains open. This results in a a shunt in which blood passes from the high pressure aorta to the pulmonary artery, to the lungs, and back to the left heart.
PDAs have an overall incidence of 1:2500 to 5000 live births.
They are more common in premature infants, who may not have responsiveness to vasoconstrictive actions.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Risk factors include first trimester rubella infection, prematurity, and birth at a high altitude.
Pathophysiology
Large left-to-right shunts can develop early congestive heart failure.
Eisenmenger syndrome can result in cyanosis and clubbing as deoxygenated blood is shunted to the aorta.
Signs and Symptoms
- history
- physical exam
History
Children with small PDAs are generally asymptomatic.
Poor feeding (sweaty, etc)
Recurrent lower RTIs
Slow growth and failure to thrive
Fatigue, dyspnea, and palpitations can occur in adolescence or adulthood with moderate-sized vessels.
Physical Exam
appearance: may have proximal muscle wasting doe to failure to thrive
resp: increased work of breathing
hepatomegaly
cardiovascular
- continuous, machine gun-like murmur best heard in the left subclavicular region.
- bounding pulse with widened pulse pressure
- tachycardia
Investigations
ECG: Atrial fibrillation may occur due to left atrial dilation.
A chest X ray shows an enlarged cardiac silouhette due to left heart enlargement, with prominent pulmonary vascular markings. Calcification of the ductus may be present.
ECG shows left atrial enlargement and left ventricular hypertrophy.
Echocardiography allows visualization of the ductus and can be used to estimate flow and pressures.
Differential Diagnosis
Treatments
Consequences and Course
Most common cause of heart failure in children.
Resources and References
Topic Development
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