Patent ductus arteriosus pathophysiology

Revision as of 17:58, 21 June 2011 by Taylor Palmieri (talk | contribs) (New page: {{SI}} {{CMG}} '''Associate Editors-In-Chief:''' {{CZ}}; Keri Shafer, M.D. [mailto:kshafer@bidmc.harvard.edu] {{EH}} ==Pathophysiology== Consequences depend on the...)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Keri Shafer, M.D. [3]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [4] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Pathophysiology

Consequences depend on the size of the defect and the pulmonary vascular resistance (PVR). [1]

Small PDA

  1. Small left-to-right shunt (Qp/Qs < 1.5).
  2. Normal ratio of pulmonary artery (PA) to systemic pressure.
  3. Shunt throughout the cardiac cycle, continuous murmur.

Medium-sized PDA

  1. Qp/Qs 1.5 to 2.0 yet small enough to offer some resistance to flow.
  2. PA systolic to systemic pressures are < 0.5.
  3. Unusual for this group to have markedly increased PVR.
  4. Due to increased return to the left heart, there is volume overload of the left atrium (LA) and the left ventricle (LV).

Large PDA

  1. Defect does not restrict flow.
  2. There is pulmonary hypertension at near systemic pressures (PA systolic/systolic pressure is >0.5).
  3. Because of the physiologic decrease in the PVR over the first three months of life there is a large left-to-right shunt with Qp/Qs > 2.
  4. The large volume overload of the left ventricle may result in LV failure.
  5. There is pulmonary hypertension.
  6. There may be two courses:
    1. A decrease in the relative size of the ductus compared with other cardiovascular structures. This results in a medium-sized defect compared with the course expected for a medium-sized defect.
    2. The development of severe pulmonary vascular obstructive disease, can occur at any time from age 3 until early adulthood. The left-to-right shunt converts to a right-to-left shunt with cyanosis and disappearance of the continuous murmur.

References

  1. Giuliani et al, Cardiology: Fundamentals and Practice, Second Edition, Mosby Year Book, Boston, 1991, pp. 1653-1663.

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