Patent Ductus

Arteriosus
Manjula J
10M4257
Defn:
Presence of communication b/n Pulmonary artery and
Aorta even after birth.

Distal to Subclavian Artery

Functionally and Anatomically closes soon after the

birth.
Haemodynamics:
Left to right shunt.

Flow occurs both during Systole and Diastole,

provided PA pressure remains normal.

Continous murmur.

During systole and diastole, overloading of the

Pulmonary artery occurs.
Large volume of blood passing through normal
aortic valve causes ejection systolic murmur.
Clinical features
Symptomatic in early life

Develops CCF- 6-10 weeks of age.

Effort intolerance, Palpitation, frequent chest infections

Wide pulse pressure

Prominent carotid pulsations

Cardiac impulse is hyperdynamic with left ventricular
type of apex

Systolic or continous thrill is palpable at 2nd left

interspace

1st sound is accentuated and 2nd narrowly or

paradoxically split with large left to right shunts,with a
delayed diastolic murmur.
Murmur starts after the 1st sound and reaches the peak
at 2nd, diminishes in intensity and only heard apart of it
in diastole.

3rd sound is heard in large shunts

ECG- Deep Q waves with tall t wave ( feature of

ventricular overloading)
Assement of severity
Depends on:

Size of the heart

Presence or absence of 3rd sound
Pulse Pressure
Complications
CCF may occur in first few weeks of life

PAH may develop earlier than VSD

PAH- either Hyperkinetic or Obstructive PAH

D/D
Coronary Arteriovenous fistula
Ruptured sinus of valsalva fistula
Aortopulmonary window
Systemic arteiovenous fistula over the chest
Bronchial collateral murmurs
Pulmonary arteiovenous fistula
Peripheral pulmonic stenosis
Small ASD with Mitral stenosis(Lutembacher
syndrome)
Treatment
Dangerous in preterm newborns- can result in heart
failure,respiratory distress, necrotizing enterocolitis.

Indomethacin 0.2mg/kg/dose, orally every 12-24 hr for

3 days and Ibuprofen

Contraindications: Hepatic or renal insufficiency and

bleeding tendencies .
Surgical ligation

In term babies spontaneous closure

Catheter based treatment (occlusive devices or coils)

Patient with PAH are considered inoperable – right to

left shunt sets in – resulting in Differntial cyanosis.
ThanQ 