Patent Ductus Arteriosus

Pathology:                    

The ductus arteriosus connects the pulmonary artery and the descending aorta; it is described as persistent if it remains open 1 month after the estimated delivery date, if it remains patent blood flows from the aorta to the pulmonary artery(left to right shunt)

Aetiology:                    

Commonin preterm neonates due to a defect in the constriction of the duct following birth

Symptoms:                  

Usually asymptomatic

Large ducts may be symptoms of heart failure and pulmonary hypertension

Signs:                              

Continuous machinery murmur beneath the left clavicle

Investigations:          

‍ECG: usually normal

Chest X-Ray: usuallynormal but large ducts may have increased pulmonary

vasculature

Echo: Assessfor structural abnormality and confirm defect

Treatment:                  

Conservative Management: May closes pontaneously

Medical: Treat symptoms of heartfailure, Indomethacin – a prostaglandin

inhibitor to assistin closure in infancy

Surgical: Ligation may be required if medical management fails

Complications:          

Heart failure, pulmonary hypertension, bacterial endocarditis, Eisenmenger

Syndrome

Prognosis:                  

Good prognosis once the PDAhas closed, however if untreated then

development of Eisenmenger Syndrome is a lifethreatening complication

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