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Patent ductus arteriosus

Last reviewed: 25 Mar 2025
Last updated: 23 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • presentation in infancy
Full details

Other diagnostic factors

  • tachypnoea/shortness of breath (SOB)
  • faltering growth
  • exercise intolerance
  • widened pulse pressure
  • machine-like continuous murmur/Gibson murmur in children born at full-term
  • apnoea
  • low diastolic blood pressure (BP)
  • irritability
  • diaphoresis
  • increased respiratory symptoms with upper respiratory tract 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 investigations

1st investigations to order

  • CXR
  • ECG
  • echocardiogram
Full details

Investigations to consider

  • cardiac catheterisation 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 Cardiology Fellow

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.

Acknowledgements

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

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.

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