Patent ductus arteriosus history and symptoms
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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];Kristin Feeney, B.S. [4]
Overview
Patent ductus arteriosus is usually an asymptomatic diagnosis, which may cause heart failure and dyspnea. Clinical manifestation differs due to the size of PDA. If the closure does not happen, it may progress to high right-sided hypertension which may cause irreversible vascular damage.
History and Symptoms
- Usually asymptomatic or may present with symptoms of heart failure and dyspnea.
- Depending on the size of the PDA, a cardiac murmur can be missed during the first physical exam of the newborn because of the high pulmonary pressure that avoids the left-to-right shunt at that time, when the pulmonary pressure drops, the murmur is evident.[1]
- Clinical manifestation of patent ductus arteriosus depends on the degree of left to right shunting which in turn is affected by:
- Size and length of the PDA
- Difference between pulmonary and systemic vascular resistances.
Small PDA
- May be asymptomatic.[2]
- Sometimes identified incidentally on routine physical examinations (due to the presence of continuous flow murmurs) or on echocardiography performed for some other conditions.
Moderate PDA
- Qp:Qs between 1.5 and 2.2 to 1
- The moderate left-to-right shunt increases the volume overload on the left side of heart and may present with exercise intolerance.
Large PDA
- Presentation of large PDA in infant and children are symptoms due to heart failure like-
- Presentation of large PDA in adults.
- It can cause left ventricular overload. However, if the condition goes uncorrected progressive rise in pulmonary artery pressure may occur that in turn can cause a reversal of shunt i.e. right to left-sided shunting.
- The right to left shunt can cause cyanosis and in later stages may progress to Eisenmenger syndrome.
References
- ↑ de Freitas Martins, Fernando; Ibarra Rios, Daniel; F. Resende, Maura Helena; Javed, Henna; Weisz, Dany; Jain, Amish; de Andrade Lopes, Jose Maria; McNamara, Patrick J. (2018). "Relationship of Patent Ductus Arteriosus Size to Echocardiographic Markers of Shunt Volume". The Journal of Pediatrics. 202: 50–55.e3. doi:10.1016/j.jpeds.2018.06.045. ISSN 0022-3476.
- ↑ Skelton R, Evans N, Smythe J (1994). "A blinded comparison of clinical and echocardiographic evaluation of the preterm infant for patent ductus arteriosus". J Paediatr Child Health. 30 (5): 406–11. doi:10.1111/j.1440-1754.1994.tb00689.x. PMID 7833075.