Patent ductus arteriosus natural history, complications, and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Priyamvada Singh, M.B.B.S. [2], Cafer Zorkun, M.D., Ph.D. [3], Ramyar Ghandriz MD[4] Assistant Editor-In-Chief: Kristin Feeney, B.S. [5]
Overview
The natural history of unoperated patients of patent ductus arteriosus (PDA) depends on the amount of left to right shunting. The left to right shunting in turn depends on the size of ductus and the difference in resistance between the left and right side of heart. PDA can cause complications such as heart failure, infective endocarditis, rhythm disturbance, pulmonary hypertension and Eisenmenger syndrome.
Natural History, Complications, and Prognosis
Natural History
Small PDA
- May remain asymptomatic[1]
- Rarely can increase the risk of endarteritis[2]
Moderate PDA
- Left sided heart dysfunction
- Rhythm disturbances like atrial fibrillation as a result of left sided dysfunction
Large PDA
- Left ventricular volume overload
- Increased pulmonary resistance
- Eisenmenger's syndrome
Complications
Heart Failure
- Clinical feature - failure to thrive, feeding difficulties and respiratory distress[3]
- If PDA left untreated it will lead to cardiac volume overload which ultimately results in heart failure
- Management involves:[4]
Infective Endocarditis
- Infective endocarditis is a very complication of persistent ductus arteriosus.[5]
- Increases risk of septic emboli to lung[6]
- PDA complicated with infective endocarditis is an indication for closure of PDA.[7]
Rhythm Disturbance
- Often associated with atrial fibrillation (left sided dysfunction).[8]
Pulmonary Hypertension
- Right ventricular impulse on palpation[9][10]
- Pulmonary ejection sound
- A loud single second heart sound
- Graham-Steel murmur: The Graham-Steel murmur of pulmonic regurgitation and hypertension. It is high-pitched and "blowing."
Complications during pregnancy
- In pregnancy PDA posses a very high significant risk for both the mother and the baby.[11][12][13][14]
- If PDA is small it is mostly asymptomatic.
- If PDA is moderate it might lead to increased pulmonary vascular resistance which complicates the pregnancy.
- If PDA is large it might lead to eisenmenger syndrome which increases both morbidity and mortality of the baby and the mother.
Prognosis
Prognosis of patent ductus arteriosus varies widely. It depends on:[15]
- The size of patent ductus arteriosus
- Whether the patient has been treated with closure medicines.
- Whether surgery has been done.
- Whether the patient with complications or not, such as heart failure, problems with lung development, or infective endocarditis.
References
- ↑ Campbell, M (1968). "Natural history of persistent ductus arteriosus". Heart. 30 (1): 4–13. doi:10.1136/hrt.30.1.4. ISSN 1355-6037.
- ↑ Sadiq M, Latif F, Ur-Rehman A (2004). "Analysis of infective endarteritis in patent ductus arteriosus". Am J Cardiol. 93 (4): 513–5. doi:10.1016/j.amjcard.2003.10.062. PMID 14969641.
- ↑ Gillam-Krakauer, Maria; Reese, Jeff (2018). "Diagnosis and Management of Patent Ductus Arteriosus". NeoReviews. 19 (7): e394–e402. doi:10.1542/neo.19-7-e394. ISSN 1526-9906.
- ↑ "StatPearls". 2020. PMID 28613509.
- ↑ Morris CD, Reller MD, Menashe VD (1998). "Thirty-year incidence of infective endocarditis after surgery for congenital heart defect". JAMA. 279 (8): 599–603. doi:10.1001/jama.279.8.599. PMID 9486754.
- ↑ Satoh, Tadashi; Nishida, Naoki (2008). "Patent Ductus Arteriosus with Infective Endocarditis at Age 92". Internal Medicine. 47 (4): 263–268. doi:10.2169/internalmedicine.47.0445. ISSN 0918-2918.
- ↑ Thilén U, Aström-Olsson K (1997). "Does the risk of infective endarteritis justify routine patent ductus arteriosus closure?". Eur Heart J. 18 (3): 503–6. doi:10.1093/oxfordjournals.eurheartj.a015272. PMID 9076389.
- ↑ Wiyono, S. A.; Witsenburg, M.; de Jaegere, P. P. T.; Roos-Hesselink, J. W. (2008). "Patent ductus arteriosus in adults". Netherlands Heart Journal. 16 (7): 255–259. doi:10.1007/BF03086157. ISSN 1568-5888.
- ↑ Lehner, Anja; Ulrich, Sarah; Happel, Christoph M.; Fischer, Marcus; Kantzis, Marinos; Schulze-Neick, Ingram; Haas, Nikolaus A. (2017). "Closure of very large PDA with pulmonary hypertension: Initial clinical case-series with the new Occlutech®PDA occluder". Catheterization and Cardiovascular Interventions. 89 (4): 718–725. doi:10.1002/ccd.26856. ISSN 1522-1946.
- ↑ Chen WJ, Chen JJ, Lin SC, Hwang JJ, Lien WP (1995). "Detection of cardiovascular shunts by transesophageal echocardiography in patients with pulmonary hypertension of unexplained cause". Chest. 107 (1): 8–13. doi:10.1378/chest.107.1.8. PMID 7813317.
- ↑ Kumar P, Sinha SK, Pandey U, Thakur R, Varma CM, Sachan M; et al. (2016). "Patent Ductus Arteriosus With Eisenmenger Syndrome: Difficult Diagnosis Made Easily With Saline Contrast Echocardiography". Cardiol Res. 7 (3): 117–118. doi:10.14740/cr447w. PMC 5295518. PMID 28197278.
- ↑ Kumar P, Sinha SK, Pandey U, Thakur R, Varma CM, Sachan M; et al. (2016). "Patent Ductus Arteriosus With Eisenmenger Syndrome: Difficult Diagnosis Made Easily With Saline Contrast Echocardiography". Cardiol Res. 7 (3): 117–118. doi:10.14740/cr447w. PMC 5295518. PMID 28197278.
- ↑ Kumar, Prakash; Sinha, Santosh Kumar; Pandey, Umeshwar; Thakur, Ramesh; Varma, Chandra Mohan; Sachan, Mohit; Goel, Amit (2016). "Patent Ductus Arteriosus With Eisenmenger Syndrome: Difficult Diagnosis Made Easily With Saline Contrast Echocardiography". Cardiology Research. 7 (3): 117–118. doi:10.14740/cr447w. ISSN 1923-2829.
- ↑ Ryan, John J.; Suksaranjit, Promporn; Hatton, Nathan; Bull, David A.; Wilson, Brent D. (2015). "Eisenmenger Syndrome With Unrepaired Patent Ductus Arteriosus". Circulation. 131 (16). doi:10.1161/CIRCULATIONAHA.114.013810. ISSN 0009-7322.
- ↑ Benn J (1947). "THE PROGNOSIS OF PATENT DUCTUS ARTERIOSUS". Br Heart J. 9 (4): 283–91. doi:10.1136/hrt.9.4.283. PMC 503595. PMID 18610079.