Patent Ductus Arteriosus Diagnosis and Management

Epidemiology and Pathophysiology

The American College of Cardiology states that patent ductus arteriosus is found in approximately 0.3% to 0.8% of term infants and is twice as common in females as males 1
The clinical manifestations of patent ductus arteriosus depend on the size of the vessel and the relative systemic and pulmonary vascular resistances 2
Patent ductus arteriosus can range from small hemodynamically insignificant lesions to large ones causing congestive heart failure and pulmonary hypertension 1

The American College of Cardiology classifies patent ductus arteriosus as trivial/silent, small/audible, or moderate to large based on hemodynamic significance 3

Small patent ductus arteriosus is often asymptomatic with normal left ventricle and pulmonary artery pressure, according to the European Heart Journal 4
Moderate patent ductus arteriosus with predominant left ventricular volume overload may present with left heart failure, as stated by the European Heart Journal 4
Large patent ductus arteriosus may develop Eisenmenger physiology with differential hypoxemia and differential cyanosis, according to the European Heart Journal 4

The American College of Cardiology recommends oxygen saturation measurement in feet and both hands to assess for right-to-left shunting 1
Echocardiography is the key diagnostic technique to confirm diagnosis, assess left ventricular volume overload, pulmonary artery pressure, and right heart changes, as stated by the European Heart Journal 4
Cardiac catheterization is useful in patients with suspected pulmonary hypertension, according to the American College of Cardiology 1

The American College of Cardiology recommends patent ductus arteriosus closure if left atrial or left ventricular enlargement is present and attributable to patent ductus arteriosus with net left-to-right shunt, pulmonary artery systolic pressure <50% systemic, and pulmonary vascular resistance <1/3 systemic 1
Device closure is the method of choice when technically suitable, as stated by the European Heart Journal 4

The American College of Cardiology states that the point of maximal impulse is typically located in the 5th intercostal space at or medial to the midclavicular line 3
Lateral displacement of the point of maximal impulse indicates left ventricular enlargement due to conditions such as aortic regurgitation, mitral regurgitation, or dilated cardiomyopathy, according to the American College of Cardiology 3

The American College of Cardiology describes the right atrium as receiving deoxygenated blood from the superior vena cava, inferior vena cava, and coronary sinus 3
The European Heart Journal states that the left ventricle receives blood from the left atrium and pumps it to the aorta 4
The American College of Cardiology explains that deoxygenated blood enters the right atrium from the body via the superior and inferior vena cavae, then flows through the tricuspid valve into the right ventricle, and finally travels to the lungs where it becomes oxygenated 3