RT Book, Section
A1 Hsia, Tain-Yen
A1 Wu, Jeffrey J.
A1 Ringel, Richard
A2 Yuh, David D.
A2 Vricella, Luca A.
A2 Yang, Stephen C.
A2 Doty, John R.
SR Print(0)
ID 1104595375
T1 Patent Ductus Arteriosus
T2 Johns Hopkins Textbook of Cardiothoracic Surgery
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-166350-2
LK accesssurgery.mhmedical.com/content.aspx?aid=1104595375
RD 2024/04/24
AB EpidemiologyThe  ductus  arteriosus  is  a  normal  fetal  structure,  that  arises  from  the  left  sixth  aortic  arch,  and  connects  the  proximal  left  main  pulmonary  artery  to  the  upper  descending  thoracic  aorta.  Persistent  patency  beyond  the  neonatal  period  occurs  in  approximately  1  in  2500  term  live  births,  with  a  male-to-female  ratio  of  2:1.  Patent  ductus  arteriosus  (PDA)  accounts  for  5  to  10  percent  of  all  congenital  heart  defects,  with  up  to  30  percent  of  cases  observed  in  preterm  infants.PathophysiologyThe  presence  of  a  large,  nonrestrictive  PDA  leads  to  left-to-right  shunting  with  pulmonary  overcirculation,  subsequent  left  atrial  dilatation,  left  ventricular  volume  overload,  and  congestive  heart  failure;  if  left  untreated,  irreversible  pulmonary  hypertension  and  Eisenmenger  physiology  with  right-to-left  shunting  and  cyanosis  ultimately  ensue.Clinical  featuresPresentation  may  range  from  absence  of  symptoms  to  the  presence  of  a  “machinery-like”  murmur  with  poor  feeding,  failure  to  thrive,  tachypnea,  and  recurrent  respiratory  infections.DiagnosisChest  x-ray  typically  discloses  increased  pulmonary  vascular  markings,  pulmonary  edema,  and  cardiomegaly.  Transthoracic  echocardiography  demonstrates  the  ductal  anatomy  and  any  coexisting  defects.TreatmentTreatment  strategies  include  pharmacologic  closure  with  indomethacin  in  premature  infants,  catheter-based  closure  with  coil  occlusion  in  older  children  and  adults,  video-assisted  thoracoscopic  (VATS)  closure,  and  conventional  thoracotomy  and  ligation.  Whereas  operative  outcomes  in  premature  newborns  are  heavily  dependent  on  associated  comorbidities,  morbidity  and  mortality  from  surgical  or  percutaneous  closure  in  infants  and  children  are  almost  negligible.