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Patent ductus arteriosus

Last reviewed: 11 Oct 2024
Last updated: 04 Jun 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presentation in infancy
Full details

Other diagnostic factors

  • tachypnea/shortness of breath (SOB)
  • failure to thrive
  • 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

  • chest x-ray
  • 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

Kenneth M. Coca, MD​

Pediatric Resident

Johns Hopkins All Children’s Hospital

Saint Petersburg

FL

Disclosures

KMC declares that he has no competing interests.

Joyce T. Johnson, MD, MS

Director, Fetal Cardiology

Johns Hopkins All Children’s Hospital

Saint Petersburg

FL

Disclosures

JTJ declares that she has no competing interests.

Nelangi M. Pinto, MD

Associate Professor, Pediatrics

University of Washington

Seattle Children’s Hospital

Seattle

WA

Disclosures

NMP declares that she has no competing interests.

Acknowledgements

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

Disclosures

ATY declares that she has no competing interests.

Peer reviewers

Michael Cheung, BSc (Hons), MB ChB, MRCP, FRACP

Acting Head

Department of Cardiology

Royal Children's Hospital

Melbourne

Australia

Disclosures

MC declares that he has no competing interests.

Rajat Bhatt, MD

Assistant Professor

Internal Medicine

Texas Tech University Health Sciences Center (TTUHSC)

Lubbock

TX

Disclosures

RB declares that he has no competing interests.

Henry M. Sondheimer, MD

Professor of Pediatrics

Clinical Director

Pediatric Cardiology

The Children's Hospital

Denver

CO

Disclosures

HMS declares that he has no competing interests.

  • Patent ductus arteriosus images
  • Differentials

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    • Left-sided shunts (ventricular septal defect, atrioventricular septal defect)
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  • Guidelines

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    • Pulmonary hypertension in congenital heart disease: a scientific statement
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