1. Patent Ductus Arteriosus
Dr. Kalpana Malla
MBBS MD (Pediatrics)
Manipal Teaching Hospital
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2. Patent ductus arteriosus
• Persistence of ductus
arteriosus
• Closes
spontaneously in
normal term infants
at 3-5 days of age

3. Patent ductus arteriosus
• 5-10 % of CHDs
• More common in premature infants
• Male: female ratio is 1:3
• Higher incidence of PDA in infants born at high
altitudes (> 10,000 feet)

4. Patent Ductus Arteriosus (PDA)
• Usually closes within 24 to 72 hours after birth
• Closure of the ductus may be delayed, or not
occur at all in preterm infants
• Patent PDA causes ↑pulmonary blood flow,
pulmonary congestion, ↑ workload of the
RV→ ↑pulmonary venous return and
↑workload of the RV

5. Hemodynamics
• L→R shunt from aorta to PA
• Flow occurs both in systole & diastole as
pressure gradient + throughout cardiac cycle
b/t two arteries- continuous murmur
• Systolic as well as diastolic overloading of pul
artery
• To lungs → Lt atrium (enlarges)
• To normal mitral valve –accentuated S1 ,mitral
delayed diastolic murmur

6. • To Lt ventricle during diastole – diastolic
overloading (LV enlarges)- prolongation of Lt
ventricle systole-delayed closure of aortic
valve late A2

7. C/F
• Depend on size of the shunt and the degree of
associated pulmonary hypertension
• Asymptomatic if small ductus
• Large ductus –
frequent lower RTIs
CHF
poor weight gain

8. Physical examination
• Tachycardia
• Exertional dyspnea
• Hyperactive precordium
• Bounding peripheral pulses with wide pulse
pressure
• Systolic thrill at upper left sternal border

9. Physical findings
• Auscultation: P2 normal or accentuated,
• Rough grade 1-4/6 continuous murmur
“machinery” murmur at left infraclavicular or
upper LSB which peaks at S2 and fades before
the S1

10. Ductus arteriosus

11. Investigations:
1. CXR: N to cardiomegaly , increased
pulmonary vascular markings
2. ECG: N or LVH , BVH in large shunts, RVH with
development of pulmonary vascular
obstructive disease
3. Echo: presence of PDA, size of cardiac
chambers

12. Management:
• Medical:
• Indomethacin ineffective in term infants
• In preterm infants indomethacin is used (80-
90% success in infants > 1200 grams) non-
surgical closure
• Subacute bacterial endocarditis prophylaxis

13. • Surgical closure:
• Surgical correction when the PDA is large
except in patients with pulmonary vascular
obstructive disease
• Transcatheter closure of small defects has
become standard therapy

14. Natural history:
• Spontaneous closure unlikely in full term
infants
• CHF & recurrent chest infections if large shunt
• Infective endocarditis
• Pulmonary vascular obstructive disease if PAH
is untreated
• PDA aneurysm may develop, rarely

15. AV Canal
• Includes:
– ASD
– VSD
– Abnormalities of the Mitral and/or Tricuspid valves
• Greater incidence in children with Down’s Syndrome

16. Thank you
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