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Patent ductus arteriosus

Last reviewed: 15 Apr 2025
Last updated: 23 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presentation in infancy
Full details

Other diagnostic factors

  • tachypnea/shortness of breath (SOB)
  • faltering growth
  • exercise intolerance
  • widened pulse pressure
  • machine-like continuous murmur/Gibson murmur in children born at full-term
  • apnea
  • low diastolic blood pressure (BP)
  • irritability
  • diaphoresis
  • increased respiratory symptoms with upper respiratory infection
  • murmur heard only during systole
  • hyperdynamic precordium
  • systolic thrill
  • third heart sound heard at apex
  • mid-diastolic rumble heard at apex
  • bounding peripheral pulses
  • pulmonary rales
Full details

Risk factors

  • prematurity
  • maternal rubella
  • female sex
  • respiratory distress syndrome (RDS)
  • high altitude
  • family history
  • black race
Full details

Diagnostic tests

1st tests to order

  • CXR
  • ECG
  • echocardiogram
Full details

Tests to consider

  • cardiac catheterization and angiography
Full details

Treatment algorithm

INITIAL

premature very low birth weight infants: prophylactic therapy

ACUTE

premature infants (<32 weeks)

term infants and children: small-to-moderate-sized ducts

term infants and children: large ducts and/or symptomatic infants too small for device closure

adults

Contributors

Authors

Pediatric Cardiology Fellow

Johns Hopkins All Children’s Hospital

Saint Petersburg

FL

Disclosures

KMC declares that he has no competing interests.

Director, Fetal Cardiology

Johns Hopkins All Children’s Hospital

Saint Petersburg

FL

Disclosures

JTJ declares that she has no competing interests.

Dr Kenneth M. Coca and Dr Joyce T. Johnson would like to gratefully acknowledge Dr Anji T. Yetman and Dr Nelangi M. Pinto, previous contributors to this topic.

Disclosures

ATY declares that she has no competing interests.

Peer reviewers

Acting Head

Department of Cardiology

Royal Children's Hospital

Melbourne

Australia

Disclosures

MC declares that he has no competing interests.

Assistant Professor

Internal Medicine

Texas Tech University Health Sciences Center (TTUHSC)

Lubbock

TX

Disclosures

RB declares that he has no competing interests.

Professor of Pediatrics

Clinical Director

Pediatric Cardiology

The Children's Hospital

Denver

CO

Disclosures

HMS declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC guidelines for the management of adult congenital heart disease. Eur Heart J. 2021 Feb 11;42(6):563-645.Full text

Hamrick SEG, Sallmon H, Rose AT, et al. Patent ductus arteriosus of the preterm infant. Pediatrics. 2020 Nov;146(5):e20201209.Full text  Abstract

Wilson WR, Gewitz M, Lockhart PB, et al. Prevention of viridans group streptococcal infective endocarditis: a scientific statement from the American Heart Association. Circulation. 2021 May 18;143(20):e963-78.Full text  Abstract

Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC guideline for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019 Apr 2;73(12):1494-563.Full text  Abstract

John AS, Jackson JL, Moons P, et al. Advances in managing transition to adulthood for adolescents with congenital heart disease: a practical approach to transition program design: a scientific statement from the American Heart Association. J Am Heart Assoc. 2022 Apr 5;11(7):e025278.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Patent ductus arteriosus images
  • Differentials

    • Venous hum
    • Coronary artery fistula
    • Left-sided shunts (ventricular septal defect, atrioventricular septal defect)
    More Differentials
  • Guidelines

    • Guidelines and recommendations for performance of the fetal echocardiogram
    • Pulmonary hypertension in congenital heart disease: a scientific statement
    More Guidelines
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