Patent ductus arteriosus

Last reviewed: 6 Jan 2023
Last updated: 03 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presentation in infancy
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • prematurity
  • maternal rubella
  • female sex
  • respiratory distress syndrome (RDS)
  • high altitude
  • family history
  • black race
More risk factors

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • ECG
  • echocardiogram
More 1st investigations to order

Investigations to consider

  • cardiac catheterization and angiography
More investigations to consider

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

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 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

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

    • Guidelines for cardiovascular intervention in adults with congenital heart disease
    • Management of the patent ductus arteriosus in preterm infants
    More Guidelines
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