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{{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] | {{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, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
====Small PDA==== | ====Small PDA==== | ||
* May remain asymptomatic | * May remain [[asymptomatic]] | ||
* Rarely can increase the risk of endarteritis | * Rarely can increase the risk of [[Endarteritis obliterans|endarteritis]] | ||
====Moderate PDA==== | ====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]] | ||
| Line 28: | Line 28: | ||
====[[Infective Endocarditis]]<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>==== | ====[[Infective Endocarditis]]<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>==== | ||
*Increases risk of [[septic emboli]] to [[lung]] | *Increases risk of [[septic emboli]] to [[lung]] | ||
*PDA complicated with [[infective endocarditis]] is an indication for closure of PDA. | *[[Patent ductus arteriosus|PDA]] complicated with [[infective endocarditis]] is an indication for closure of [[Patent ductus arteriosus|PDA]]. | ||
====Rhythm Disturbance==== | ====Rhythm Disturbance==== | ||
| Line 34: | Line 34: | ||
====[[Pulmonary Hypertension]]<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>==== | ====[[Pulmonary Hypertension]]<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>==== | ||
* Right ventricular impulse on palpation | *[[Right ventricle|Right ventricular]] impulse on [[palpation]] | ||
* Pulmonary ejection sound | *[[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." | ||
====[[Eisenmenger Syndrome]]<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>==== | ====[[Eisenmenger Syndrome]]<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>==== | ||
===Prognosis=== | ===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> | [[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. | ||
Revision as of 19:35, 10 March 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
- Rarely can increase the risk of endarteritis
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[1]
- Clinical feature - failure to thrive, feeding difficulties and respiratory distress
- Management involves:[2]
Infective Endocarditis[3]
- Increases risk of septic emboli to lung
- PDA complicated with infective endocarditis is an indication for closure of PDA.
Rhythm Disturbance
- Often associated with atrial fibrillation (left sided dysfunction).[4]
Pulmonary Hypertension[5]
- Right ventricular impulse on palpation
- 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."
Eisenmenger Syndrome[6]
Prognosis
Prognosis of patent ductus arteriosus varies widely. It depends on:[7]
- 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
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.