Patent ductus arteriosus ACC/AHA guidelines

Recommendations

Major Recommendations

The American College of Cardiology/American Heart Association (ACC/AHA) classification of the recommendations for patient evaluation and treatment (classes I-III) and the levels of evidence (A-C) are defined at the end of the "Major Recommendations" field.

Recommendations for Evaluation of the Unoperated Patient

Class I

• Definitive diagnosis of patent ductus arteriosus (PDA) should be based on visualization by imaging techniques and demonstrations of the shunting across the defect (with or without evidence of clinically significant left ventricular [LV] volume overload). (Level of Evidence: C)

Class III

• Diagnostic cardiac catheterization is not indicated for uncomplicated PDA with adequate noninvasive imaging. (Level of Evidence: B)
• Maximal exercise testing is not recommended in PDA with significant pulmonary arterial hypertension (PAH). (Level of Evidence: B)

Management Strategies

Recommendations for Medical Therapy

Class I

• Routine follow-up is recommended for patients with a small PDA without evidence of left-sided heart volume overload. Follow-up is recommended every 3 to 5 years for patients with a small PDA without evidence of left-heart volume overload. (Level of Evidence: C)

Class III

• Endocarditis prophylaxis is not recommended for those with a repaired PDA without residual shunt. (Level of Evidence: C)

Recommendations for Closure of Patent Ductus Arteriosus

Class I

• Closure of a PDA either percutaneously or surgically is indicated for the following:
  • Left atrial and/or LV enlargement or if PAH is present, or in the presence of net left-to-right shunting. (Level of Evidence: C)
  • Prior endarteritis. (Level of Evidence: C)
• Consultation with adult congenital heart disease (ACHD) interventional cardiologists is recommended before surgical closure is selected as the method of repair for patients with a calcified PDA. (Level of Evidence: C)
• Surgical repair by a surgeon experienced in CHD surgery is recommended when:
  • The PDA is too large for device closure. (Level of Evidence: C)
  • Distorted ductal anatomy precludes device closure (e.g., aneurysm or endarteritis). (Deanfield et al., 2003) (Level of Evidence: B)

Class IIa

• It is reasonable to close an asymptomatic small PDA by catheter device. (Level of Evidence: C)
• PDA closure is reasonable for patients with PAH with a net left-to-right shunt. (Level of Evidence: C)

Class III

• PDA closure is not indicated for patients with PAH and net right-to-left shunt. (Level of Evidence: C)