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Patent ductus arteriosus

Radswiki and Dr Yuranga Weerakkody et al.

A patent ductus arteriosus (PDA) is a congenital cardiac anomaly with persistent patency of the ductus arteriosus (6^th aortic arch).

A ductus is a necessity in in utero but usually undergoes functional closure by around 48 hours following birth. It may remain patent in some circumstances. PDA prevalance can be up to 12% of congenital cardiac anomalies ⁴.

Commonly occurs as an isolated phenomenon but can also occur in combination with other cardiac anomalies.

A persistant PDA can be beneficial through compensatory effects when present with certain other anomalies such as

Clinical features

A large PDA classically gives a loud continuous machinary like murmur

Non cardiac associations

Radiographic features

Plain film

X ray features may vary depending on whether it is isolated or associated with other cardiac anomalies and with direction of shunt flow (right to left or left to right). Can have cardiomegaly (predominantly left atrial and left ventricular enlargement if not complicated). Obscuration of the aortopulmonary window and features of pulmonary oedema may be evident.

CT

MDCT can non invasively provide detailed anatomical information¹.

Echocardiography / Ultrasound

Direct visualisation of PDA. Colour doppler can provide information of direction of flow.

Complications

Eisenmenger phenomenon

Management

medical
- prostaglandin E1 > to keep ductus open
- indomethacin > to close ductus
endovascular
- various closure devices
surgical
- clipping or ligation to close.

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