Patent ductus arteriosus natural history, complications, and prognosis: Difference between revisions
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{{Patent ductus arteriosus}} | {{Patent ductus arteriosus}} | ||
{{CMG}}; '''Associate Editor-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com], {{CZ}}, '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] | {{CMG}}; '''Associate Editor-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com], {{CZ}}, {{RG}} '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] | ||
==Overview== | ==Overview== | ||
The natural history of unoperated patients of patent ductus arteriosus depends on the amount of [[left-to-right shunt|left to right shunting]]. The left to right shunting in turn depends on the size of ductus and the difference in resistance between the left and right side of [[heart]]. PDA can cause complications such as [[heart failure]], [[infective endocarditis]], rhythm disturbance, [[pulmonary hypertension]] and [[Eisenmenger syndrome]]. | The natural history of unoperated patients of [[patent ductus arteriosus]] ([[Patent ductus arteriosus|PDA]]) depends on the amount of [[left-to-right shunt|left to right shunting]]. The left to right shunting in turn depends on the size of [[ductus]] and the difference in resistance between the left and right side of [[heart]]. [[Patent ductus arteriosus|PDA]] can cause [[complications]] such as [[heart failure]], [[infective endocarditis]], rhythm disturbance, [[pulmonary hypertension]] and [[Eisenmenger syndrome]]. | ||
==Natural History, Complications, and Prognosis== | |||
===Natural History=== | |||
====Small PDA==== | |||
* May remain [[asymptomatic]]<ref name="Campbell1968">{{cite journal|last1=Campbell|first1=M|title=Natural history of persistent ductus arteriosus.|journal=Heart|volume=30|issue=1|year=1968|pages=4–13|issn=1355-6037|doi=10.1136/hrt.30.1.4}}</ref> | |||
* Rarely can increase the risk of [[Endarteritis obliterans|endarteritis]]<ref name="pmid14969641">{{cite journal| author=Sadiq M, Latif F, Ur-Rehman A| title=Analysis of infective endarteritis in patent ductus arteriosus. | journal=Am J Cardiol | year= 2004 | volume= 93 | issue= 4 | pages= 513-5 | pmid=14969641 | doi=10.1016/j.amjcard.2003.10.062 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14969641 }}</ref> | |||
== | ====Moderate PDA==== | ||
* Left sided heart dysfunction | * Left sided heart dysfunction | ||
* Rhythm disturbances like [[atrial fibrillation]] as a result of left sided dysfunction | *[[Rhythm]] disturbances like [[atrial fibrillation]] as a result of left sided dysfunction | ||
===Large PDA=== | ====Large PDA==== | ||
* Left ventricular volume overload | *[[Left ventricle|Left ventricular]] volume overload | ||
* Increased pulmonary resistance | * Increased [[pulmonary]] resistance | ||
* [[Eisenmenger's syndrome]] | * [[Eisenmenger's syndrome]] | ||
==Complications== | ===Complications=== | ||
=== | ====Heart Failure==== | ||
*Clinical feature - [[failure to thrive]], feeding difficulties and [[respiratory distress]] | *Clinical feature - [[failure to thrive]], feeding difficulties and [[respiratory distress]]<ref name="Gillam-KrakauerReese2018">{{cite journal|last1=Gillam-Krakauer|first1=Maria|last2=Reese|first2=Jeff|title=Diagnosis and Management of Patent Ductus Arteriosus|journal=NeoReviews|volume=19|issue=7|year=2018|pages=e394–e402|issn=1526-9906|doi=10.1542/neo.19-7-e394}}</ref> | ||
*Management involves | *If PDA left untreated it will lead to cardiac volume overload which ultimately results in heart failure | ||
**Medical treatment with [[digoxin]] and [[diuretic]] | *Management involves:<ref name="pmid28613509">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=28613509 | doi= | pmc= | url= }}</ref> | ||
**Medical treatment with [[digoxin]] and [[diuretic]] | |||
**Surgical closure | **Surgical closure | ||
=== | ====Infective Endocarditis==== | ||
=== | * [[Infective endocarditis]] is a very complication of persistent ductus arteriosus.<ref name="pmid9486754">{{cite journal| author=Morris CD, Reller MD, Menashe VD| title=Thirty-year incidence of infective endocarditis after surgery for congenital heart defect. | journal=JAMA | year= 1998 | volume= 279 | issue= 8 | pages= 599-603 | pmid=9486754 | doi=10.1001/jama.279.8.599 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9486754 }}</ref> | ||
===[[Pulmonary Hypertension | *Increases risk of [[septic emboli]] to [[lung]]<ref name="SatohNishida2008">{{cite journal|last1=Satoh|first1=Tadashi|last2=Nishida|first2=Naoki|title=Patent Ductus Arteriosus with Infective Endocarditis at Age 92|journal=Internal Medicine|volume=47|issue=4|year=2008|pages=263–268|issn=0918-2918|doi=10.2169/internalmedicine.47.0445}}</ref> | ||
* Right ventricular impulse on palpation | *[[Patent ductus arteriosus|PDA]] complicated with [[infective endocarditis]] is an indication for closure of [[Patent ductus arteriosus|PDA]].<ref name="pmid9076389">{{cite journal| author=Thilén U, Aström-Olsson K| title=Does the risk of infective endarteritis justify routine patent ductus arteriosus closure? | journal=Eur Heart J | year= 1997 | volume= 18 | issue= 3 | pages= 503-6 | pmid=9076389 | doi=10.1093/oxfordjournals.eurheartj.a015272 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9076389 }}</ref> | ||
* Pulmonary ejection sound | |||
====Rhythm Disturbance==== | |||
*Often associated with [[atrial fibrillation]] (left sided dysfunction).<ref name="WiyonoWitsenburg2008">{{cite journal|last1=Wiyono|first1=S. A.|last2=Witsenburg|first2=M.|last3=de Jaegere|first3=P. P. T.|last4=Roos-Hesselink|first4=J. W.|title=Patent ductus arteriosus in adults|journal=Netherlands Heart Journal|volume=16|issue=7|year=2008|pages=255–259|issn=1568-5888|doi=10.1007/BF03086157}}</ref> | |||
====Pulmonary Hypertension==== | |||
*[[Right ventricle|Right ventricular]] impulse on [[palpation]]<ref name="LehnerUlrich2017">{{cite journal|last1=Lehner|first1=Anja|last2=Ulrich|first2=Sarah|last3=Happel|first3=Christoph M.|last4=Fischer|first4=Marcus|last5=Kantzis|first5=Marinos|last6=Schulze-Neick|first6=Ingram|last7=Haas|first7=Nikolaus A.|title=Closure of very large PDA with pulmonary hypertension: Initial clinical case-series with the new Occlutech®PDA occluder|journal=Catheterization and Cardiovascular Interventions|volume=89|issue=4|year=2017|pages=718–725|issn=15221946|doi=10.1002/ccd.26856}}</ref><ref name="pmid7813317">{{cite journal| author=Chen WJ, Chen JJ, Lin SC, Hwang JJ, Lien WP| title=Detection of cardiovascular shunts by transesophageal echocardiography in patients with pulmonary hypertension of unexplained cause. | journal=Chest | year= 1995 | volume= 107 | issue= 1 | pages= 8-13 | pmid=7813317 | doi=10.1378/chest.107.1.8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7813317 }}</ref> | |||
*[[Pulmonary]] ejection sound | |||
* A [[heart sounds#Loud P2|loud single second heart sound]] | * A [[heart sounds#Loud P2|loud single second heart sound]] | ||
* Graham Steel murmur: The [[Graham-Steell murmur|Graham-Steel murmur]] of [[pulmonic regurgitation]] and [[Pulmonary hypertension|hypertension]]. It is high-pitched and "blowing." | *[[Graham-Steell murmur|Graham-Steel murmur]]: The [[Graham-Steell murmur|Graham-Steel murmur]] of [[pulmonic regurgitation]] and [[Pulmonary hypertension|hypertension]]. It is high-pitched and "blowing." | ||
'''Complications during pregnancy''' | |||
* In pregnancy [[Patent ductus arteriosus|PDA]] posses a very high significant risk for both the mother and the baby.<ref name="pmid28197278">{{cite journal| author=Kumar P, Sinha SK, Pandey U, Thakur R, Varma CM, Sachan M | display-authors=etal| title=Patent Ductus Arteriosus With Eisenmenger Syndrome: Difficult Diagnosis Made Easily With Saline Contrast Echocardiography. | journal=Cardiol Res | year= 2016 | volume= 7 | issue= 3 | pages= 117-118 | pmid=28197278 | doi=10.14740/cr447w | pmc=5295518 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28197278 }}</ref><ref name="pmid281972782">{{cite journal| author=Kumar P, Sinha SK, Pandey U, Thakur R, Varma CM, Sachan M | display-authors=etal| title=Patent Ductus Arteriosus With Eisenmenger Syndrome: Difficult Diagnosis Made Easily With Saline Contrast Echocardiography. | journal=Cardiol Res | year= 2016 | volume= 7 | issue= 3 | pages= 117-118 | pmid=28197278 | doi=10.14740/cr447w | pmc=5295518 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28197278 }}</ref><ref name="KumarSinha2016">{{cite journal|last1=Kumar|first1=Prakash|last2=Sinha|first2=Santosh Kumar|last3=Pandey|first3=Umeshwar|last4=Thakur|first4=Ramesh|last5=Varma|first5=Chandra Mohan|last6=Sachan|first6=Mohit|last7=Goel|first7=Amit|title=Patent Ductus Arteriosus With Eisenmenger Syndrome: Difficult Diagnosis Made Easily With Saline Contrast Echocardiography|journal=Cardiology Research|volume=7|issue=3|year=2016|pages=117–118|issn=1923-2829|doi=10.14740/cr447w}}</ref><ref name="RyanSuksaranjit2015">{{cite journal|last1=Ryan|first1=John J.|last2=Suksaranjit|first2=Promporn|last3=Hatton|first3=Nathan|last4=Bull|first4=David A.|last5=Wilson|first5=Brent D.|title=Eisenmenger Syndrome With Unrepaired Patent Ductus Arteriosus|journal=Circulation|volume=131|issue=16|year=2015|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.114.013810}}</ref> | |||
* If [[Patent ductus arteriosus|PDA]] is small it is mostly [[asymptomatic]]. | |||
* If [[Patent ductus arteriosus|PDA]] is moderate it might lead to increased [[pulmonary]] [[vascular resistance]] which complicates the [[pregnancy]]. | |||
* If [[Patent ductus arteriosus|PDA]] is large it might lead to [[eisenmenger syndrome]] which increases both [[morbidity]] and [[mortality]] of the baby and the mother. | |||
===[[ | ===Prognosis=== | ||
[[Prognosis]] of [[patent ductus arteriosus]] varies widely. It depends on:<ref name="pmid18610079">{{cite journal| author=Benn J| title=THE PROGNOSIS OF PATENT DUCTUS ARTERIOSUS. | journal=Br Heart J | year= 1947 | volume= 9 | issue= 4 | pages= 283-91 | pmid=18610079 | doi=10.1136/hrt.9.4.283 | pmc=503595 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18610079 }}</ref> | |||
*The size of [[patent ductus arteriosus]] | |||
*The size of patent ductus arteriosus | |||
*Whether the patient has been treated with closure medicines. | *Whether the patient has been treated with closure medicines. | ||
*Whether [[surgery]] has been done. | *Whether [[surgery]] has been done. | ||
Latest revision as of 12:48, 16 July 2020
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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], Ramyar Ghandriz MD[4] Assistant Editor-In-Chief: Kristin Feeney, B.S. [5]
Overview
The natural history of unoperated patients of patent ductus arteriosus (PDA) depends on the amount of left to right shunting. The left to right shunting in turn depends on the size of ductus and the difference in resistance between the left and right side of heart. PDA can cause complications such as heart failure, infective endocarditis, rhythm disturbance, pulmonary hypertension and Eisenmenger syndrome.
Natural History, Complications, and Prognosis
Natural History
Small PDA
- May remain asymptomatic[1]
- Rarely can increase the risk of endarteritis[2]
Moderate PDA
- Left sided heart dysfunction
- Rhythm disturbances like atrial fibrillation as a result of left sided dysfunction
Large PDA
- Left ventricular volume overload
- Increased pulmonary resistance
- Eisenmenger's syndrome
Complications
Heart Failure
- Clinical feature - failure to thrive, feeding difficulties and respiratory distress[3]
- If PDA left untreated it will lead to cardiac volume overload which ultimately results in heart failure
- Management involves:[4]
Infective Endocarditis
- Infective endocarditis is a very complication of persistent ductus arteriosus.[5]
- Increases risk of septic emboli to lung[6]
- PDA complicated with infective endocarditis is an indication for closure of PDA.[7]
Rhythm Disturbance
- Often associated with atrial fibrillation (left sided dysfunction).[8]
Pulmonary Hypertension
- Right ventricular impulse on palpation[9][10]
- Pulmonary ejection sound
- A loud single second heart sound
- Graham-Steel murmur: The Graham-Steel murmur of pulmonic regurgitation and hypertension. It is high-pitched and "blowing."
Complications during pregnancy
- In pregnancy PDA posses a very high significant risk for both the mother and the baby.[11][12][13][14]
- If PDA is small it is mostly asymptomatic.
- If PDA is moderate it might lead to increased pulmonary vascular resistance which complicates the pregnancy.
- If PDA is large it might lead to eisenmenger syndrome which increases both morbidity and mortality of the baby and the mother.
Prognosis
Prognosis of patent ductus arteriosus varies widely. It depends on:[15]
- The size of patent ductus arteriosus
- Whether the patient has been treated with closure medicines.
- Whether surgery has been done.
- Whether the patient with complications or not, such as heart failure, problems with lung development, or infective endocarditis.
References
- ↑ Campbell, M (1968). "Natural history of persistent ductus arteriosus". Heart. 30 (1): 4–13. doi:10.1136/hrt.30.1.4. ISSN 1355-6037.
- ↑ Sadiq M, Latif F, Ur-Rehman A (2004). "Analysis of infective endarteritis in patent ductus arteriosus". Am J Cardiol. 93 (4): 513–5. doi:10.1016/j.amjcard.2003.10.062. PMID 14969641.
- ↑ Gillam-Krakauer, Maria; Reese, Jeff (2018). "Diagnosis and Management of Patent Ductus Arteriosus". NeoReviews. 19 (7): e394–e402. doi:10.1542/neo.19-7-e394. ISSN 1526-9906.
- ↑ "StatPearls". 2020. PMID 28613509.
- ↑ Morris CD, Reller MD, Menashe VD (1998). "Thirty-year incidence of infective endocarditis after surgery for congenital heart defect". JAMA. 279 (8): 599–603. doi:10.1001/jama.279.8.599. PMID 9486754.
- ↑ Satoh, Tadashi; Nishida, Naoki (2008). "Patent Ductus Arteriosus with Infective Endocarditis at Age 92". Internal Medicine. 47 (4): 263–268. doi:10.2169/internalmedicine.47.0445. ISSN 0918-2918.
- ↑ Thilén U, Aström-Olsson K (1997). "Does the risk of infective endarteritis justify routine patent ductus arteriosus closure?". Eur Heart J. 18 (3): 503–6. doi:10.1093/oxfordjournals.eurheartj.a015272. PMID 9076389.
- ↑ Wiyono, S. A.; Witsenburg, M.; de Jaegere, P. P. T.; Roos-Hesselink, J. W. (2008). "Patent ductus arteriosus in adults". Netherlands Heart Journal. 16 (7): 255–259. doi:10.1007/BF03086157. ISSN 1568-5888.
- ↑ Lehner, Anja; Ulrich, Sarah; Happel, Christoph M.; Fischer, Marcus; Kantzis, Marinos; Schulze-Neick, Ingram; Haas, Nikolaus A. (2017). "Closure of very large PDA with pulmonary hypertension: Initial clinical case-series with the new Occlutech®PDA occluder". Catheterization and Cardiovascular Interventions. 89 (4): 718–725. doi:10.1002/ccd.26856. ISSN 1522-1946.
- ↑ Chen WJ, Chen JJ, Lin SC, Hwang JJ, Lien WP (1995). "Detection of cardiovascular shunts by transesophageal echocardiography in patients with pulmonary hypertension of unexplained cause". Chest. 107 (1): 8–13. doi:10.1378/chest.107.1.8. PMID 7813317.
- ↑ Kumar P, Sinha SK, Pandey U, Thakur R, Varma CM, Sachan M; et al. (2016). "Patent Ductus Arteriosus With Eisenmenger Syndrome: Difficult Diagnosis Made Easily With Saline Contrast Echocardiography". Cardiol Res. 7 (3): 117–118. doi:10.14740/cr447w. PMC 5295518. PMID 28197278.
- ↑ Kumar P, Sinha SK, Pandey U, Thakur R, Varma CM, Sachan M; et al. (2016). "Patent Ductus Arteriosus With Eisenmenger Syndrome: Difficult Diagnosis Made Easily With Saline Contrast Echocardiography". Cardiol Res. 7 (3): 117–118. doi:10.14740/cr447w. PMC 5295518. PMID 28197278.
- ↑ Kumar, Prakash; Sinha, Santosh Kumar; Pandey, Umeshwar; Thakur, Ramesh; Varma, Chandra Mohan; Sachan, Mohit; Goel, Amit (2016). "Patent Ductus Arteriosus With Eisenmenger Syndrome: Difficult Diagnosis Made Easily With Saline Contrast Echocardiography". Cardiology Research. 7 (3): 117–118. doi:10.14740/cr447w. ISSN 1923-2829.
- ↑ Ryan, John J.; Suksaranjit, Promporn; Hatton, Nathan; Bull, David A.; Wilson, Brent D. (2015). "Eisenmenger Syndrome With Unrepaired Patent Ductus Arteriosus". Circulation. 131 (16). doi:10.1161/CIRCULATIONAHA.114.013810. ISSN 0009-7322.
- ↑ Benn J (1947). "THE PROGNOSIS OF PATENT DUCTUS ARTERIOSUS". Br Heart J. 9 (4): 283–91. doi:10.1136/hrt.9.4.283. PMC 503595. PMID 18610079.