Patent Ductus Arteriosus

Pathology:                    

The ductus arteriosus is an anatomical structure that connects the pulmonary artery to the descending aorta. It is considered to be persistent, occuring if it remains open at least one month after the expected delivery date. This type of persistence creates a left to right shunt, allowing blood to move from the aorta to the pulmonary artery.

Aetiology:                    

This issue is most commonly seen in preterm neonates, likely due to a failure in the constriction of the duct immediately following delivery.

Symptoms:                  

Persistent ductus arteriosus is usually asymptomatic, though in cases of larger ducts, patients may experience symptoms of heart failure and pulmonary hypertension.

Signs:                              

The main sign of persistent ductus arteriosus is a continuous machinery murmur beneath the left clavicle.

Investigations:          

• ECG: usually normal
• Chest X-Ray: usually normal but large ducts may have increased pulmonary vasculature
• Echo: Assess for structural abnormality and confirm defect

Treatment:                  

There are two main treatment options for persistent ductus arteriosus: conservative management and medical or surgical intervention.

• Conservative Management: The duct may close spontaneously over time.
• Medical Management: Treat symptoms of heart failure and administer indomethacin, a prostaglandin inhibitor, to assist in closure in infancy.
• Surgical Management: If medical management fails, ligation of the duct may be necessary.

Complications:          

If left untreated, persistent ductus arteriosus can lead to serious complications, including heart failure, pulmonary hypertension, bacterial endocarditis, and the life-threatening Eisenmenger Syndrome.

Prognosis:                  

The prognosis for persistent ductus arteriosus is generally good following closure of the duct. However, if it remains untreated, the development of Eisenmenger Syndrome is a potential consequence.

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