Patent ductus arteriosus

Patent ductus arteriosus or arteriosum (PDA) is a congenital cardiac anomaly where there is persistent patency of the ductus arteriosus, a normal connection of the fetal circulation between the aorta and the pulmonary arterial system that develops from the 6th aortic arch.

PDAs occur in ~1 in 2000 full-term neonates with a F:M of 2:1 7,8.

A large PDA classically gives a loud continuous machine-like murmur.

The ductus is a necessity in utero but usually undergoes functional closure 48 hours after birth. Patency of the ductus may be isolated or associated with other cardiac anomalies. In some circumstances, it is necessary to prolong life in patients with severe structural heart disease in whom a normal systemic circulation would be incompatible with life:

Non-cardiac associations
Plain radiograph

Chest radiographic features may vary depending on whether it is isolated or associated with other cardiac anomalies and with the 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.

Echocardiography

Direct visualisation of PDA. Colour Doppler can provide information of the direction of flow.

CT

MDCT can non-invasively provide detailed anatomical information1.

Krichenko classification based on CT angiography:

  • type A: conical ductus, prominent aortic ampulla with narrowing at pulmonary artery end
  • type B: window, short and wide ductus with blending of pulmonary artery
  • type C: long tubular ductus with no constrictions
  • type D: multiple constrictions with complex ductus
  • type E: elongated ductus with remote constriction

A ductus may have a tortuous morphology that does not fit in the Krichenko classification. This ductus type is usually observed in premature children and some authors proposed to classify it as type F or fetal type. Compared to types A to E, a type F ductus is larger, longer, tapers minimally from the aortic to pulmonary end, with a tortuous connection to the pulmonary artery giving a hockey-stick appearance 9

  • medical 
    • prostaglandin E1: to keep ductus open
    • indomethacin: to close the ductus
  • endovascular 
    • various closure devices
  • surgical 
    • clipping or ligation to close
Complications
Congenital heart disease

There is more than one way to present the variety of congenital heart diseases. Whichever way they are categorised, it is helpful to have a working understanding of normal and fetal circulation, as well as an understanding of the segmental approach to imaging in congenital heart disease.

Share article

Article information

rID: 7355
Section: Pathology
Synonyms or Alternate Spellings:
  • Patent ductus arteriosus (PDA)
  • PDA
  • Patent Botallo's duct
  • Patent ductus arteriosum

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Figure 1
    Drag here to reorder.
  • Drag
    Case 1: repaired with closure device
    Drag here to reorder.
  • Drag
    Figure 2: Krichenko classification
    Drag here to reorder.
  • Drag
    Case 2: CT
    Drag here to reorder.
  • Drag
    Case 3: pre and post closure
    Drag here to reorder.
  • Drag
    Case 4: pre and post closure
    Drag here to reorder.
  • Drag
    Case 5: CT
    Drag here to reorder.
  • Drag
    Case 6
    Drag here to reorder.
  • Drag
    Case 7: repaired with closure device
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.