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], Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]

Overview

The natural history of unoperated patients of patent ductus arteriosus 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

Small PDA

• May remain asymptomatic
• Rarely can increase the risk of endarteritis

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
• Management involves-
  • Medical treatment with digoxin and diuretic
  • Surgical closure

Infective Endocarditis

• Increases risk of septic emboli to lung
• PDA complicated with infective endocarditis is an indication for closure of PDA (ACC/AHA, 2008)

Rhythm disturbance

• Often associated with atrial fibrillation (left sided dysfunction).

Pulmonary hypertension

• Right ventricular impulse on palpation
• 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."

Prognosis

Prognosis of patent ductus arteriosus varies widely. It depends on:

• 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