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Total Anomalous Pulmonary Venous Connection Coarctication of the Aorta Patent Ductus Arteriosus Interrupted Aortic Arch Vascular Rings and Slings D-Transposition of Great Arteries Congenitally "Corrected" Transposition of Great Arteries Double Outlet Right Ventricle

Patent Ductus Arteriosus

  • A diagnosis of patent ductus arteriosus is made when the ductus fails to functionally close within the normal time frame, which in 90% of full-term infants, is within 48 hours of birth (Keane). The ductus remains patent for up to 10 days in infants with circulatory or ventilatory anomalies and even longer in premature infants.
  • During fetal life, the ductus arteriosus connects the main pulmonary artery and aorta, carrying outflow from the right ventricle to descending aorta and largely bypassing the lungs. Pulmonary resistance falls rapidly after birth when the infant takes its first breaths. In the normal situation, muscular constriction closes the ductus within a few hours. The lumen is then obliterated in a complex process requiring interactions between prostaglandins, changes in the level of arterial oxygen, genetics, and other unknown factors. This causes the patent tube of the ductus arteriosus to become a fibrous strand connecting the aorta and pulmonary trunk, referred to as the ligamentum arteriosus.
  • If the ductus arteriosus fails to close, the aortic and pulmonary arterial pressures equilibrate. This results in a decrease in pulmonary resistance which leads to left-to-right shunting and congestive heart failure. Excessive blood flow from the aorta to the pulmonary artery through a patent ductus leads to volume overload in the lungs, left atrium and ventricle, and ascending aorta. This may result in hypertrophy of structures, increased arterial pulse pressures, or pulmonary hypertension.
  • The clinical manifestations of patent ductus arteriosus vary depending on the amount of blood passing into the pulmonary circulation ranging from a murmur heard on auscultation to congestive heart failure and pulmonary hypertension.
  • The goal in management of patent ductus is to interrupt left-to-right shunting which, in turn, eliminates congestive heart failure, prevents pulmonary vascular disease and infective endocarditis, and promotes growth in infants of low birth weight. Surgical intervention is generally recommended for every patient with a patent ductus arteriosus that is not associated with other defects.