eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Patent Ductus Arteriosus: Differential Diagnoses & Workup

Author: Steven R Neish, MD, SM, Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Jul 23, 2009

Differential Diagnoses

Aortopulmonary Septal Defect
Coronary Artery Fistula
Sinus of Valsalva Aneurysm
Tetralogy of Fallot With Absent Pulmonary Valve

Other Problems to Be Considered

Venous hum
Atrioventricular malformation

Workup

Imaging Studies

The following studies are indicated in patent ductus arteriosus (PDA):

  • Chest radiography
    • If significant left-to-right shunt through the patent ductus arteriosus is present, the pulmonary arteries, pulmonary veins, left atrium, and left ventricle are enlarged. Also, the ascending aorta may be prominent.
    • Usually, chest radiographic findings are normal until the magnitude of the ratio of pulmonary to systemic circulation (QP/QS) exceeds 2:1. With marked pulmonary overcirculation, pulmonary edema may occur. In elderly individuals, the patent ductus arteriosus may calcify and may be visible on a standard radiograph.
  • Doppler echocardiography
    • The echocardiographic findings are typically diagnostic. Relying on alternative imaging techniques to make the diagnosis of patent ductus arteriosus is unusual. By 2-dimensional echocardiography, the patent ductus arteriosus can be seen most easily in the parasternal short axis view and from the suprasternal notch. The classic patent ductus arteriosus connects the junction of the main pulmonary artery and the left pulmonary artery with the aorta just below and opposite the left subclavian artery.
    • If no other abnormalities are present, Doppler echocardiography reveals continuous flow from the aorta into the main pulmonary artery. If the magnitude of the left-to-right shunt is large, continued flow around the aortic arch into the ductus arteriosus in diastole and flow reversal in the descending aorta are evident. Also, variable levels of continuous flow in the branch pulmonary arteries related to the magnitude of shunt are observed. As the shunt magnitude increases, increased flow in the pulmonary veins is evident and the left atrium enlarges. With a small or moderate-sized patent ductus arteriosus, the left ventricular size is often normal, but as shunt magnitude increases, the left ventricular diastolic size also increases.

Other Tests

  • With a small patent ductus arteriosus, the ECG findings are typically normal. Left ventricular hypertrophy may be present with a larger patent ductus arteriosus. This is typically seen as tall R waves in the lateral precordial leads (V6).
  • In the neonate, especially the premature neonate with a large patent ductus arteriosus, T-wave inversion and ST segment depression may be present, suggesting ischemia or a supply-demand mismatch. This is thought to be related to increased myocardial work due to the left-to-right shunt and pulmonary overcirculation in the face of low aortic and coronary diastolic blood pressure due to the runoff of blood from the aorta into the pulmonary arteries.

More on Patent Ductus Arteriosus

Overview: Patent Ductus Arteriosus
Differential Diagnoses & Workup: Patent Ductus Arteriosus
Treatment & Medication: Patent Ductus Arteriosus
Follow-up: Patent Ductus Arteriosus
Multimedia: Patent Ductus Arteriosus
References
[ CLOSE WINDOW ]

References

  1. Cassels DE, Bharati S, Lev M. The natural history of the ductus arteriosus in association with other congenital heart defects. Perspect Biol Med. Summer 1975;18(4):541-72. [Medline].

  2. Campbell DC, Hood RH Jr, Dooley BN. Patent ductus arteriosus. Review of literature and experience with surgical corrections. J Lancet. Oct 1967;87(10):415-8. [Medline].

  3. [Best Evidence] Ohlsson A, Walia R, Shah S. Ibuprofen for the treatment of patent ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev. Jan 23 2008;CD003481. [Medline].

  4. Sekar KC, Corff KE. Treatment of patent ductus arteriosus: indomethacin or ibuprofen?. J Perinatol. May 2008;28 Suppl 1:S60-2. [Medline].

  5. Brion LP, Soll RF. Diuretics for respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev. Jan 23 2008;CD001454. [Medline].

  6. [Best Evidence] Attridge JT, Kaufman DA, Lim DS. B-type natriuretic peptide concentrations to guide treatment of patent ductus arteriosus. Arch Dis Child Fetal Neonatal Ed. May 2009;94(3):F178-82. [Medline].

  7. Bose CL, Laughon MM. Patent ductus arteriosus: lack of evidence for common treatments. Arch Dis Child Fetal Neonatal Ed. Nov 2007;92(6):F498-502. [Medline].

  8. Cambier PA, Kirby WC, Wortham DC, Moore JW. Percutaneous closure of the small (less than 2.5 mm) patent ductus arteriosus using coil embolization. Am J Cardiol. Mar 15 1992;69(8):815-6. [Medline].

  9. Corbet AJ. Medical manipulation of the ductus arteriosus. In: The Science and Practice of Pediatric Cardiology. Lippincott Williams & Wilkins; 1997:2489-514.

  10. Dudell GG, Gersony WM. Patent ductus arteriosus in neonates with severe respiratory disease. J Pediatr. Jun 1984;104(6):915-20. [Medline].

  11. Gross RE, Hubbard JP. Surgical ligation of a patent ductus arteriosus. JAMA. 1939;112:729-31.

  12. Heymann MA, Rudolph AM. Control of the ductus arteriosus. Physiol Rev. Jan 1975;55(1):62-78. [Medline].

  13. [Best Evidence] Madan JC, Kendrick D, Hagadorn JI, Frantz ID 3rd. Patent ductus arteriosus therapy: impact on neonatal and 18-month outcome. Pediatrics. Feb 2009;123(2):674-81. [Medline].

  14. Mahony L, Carnero V, Brett C, et al. Prophylactic indomethacin therapy for patent ductus arteriosus in very- low-birth-weight infants. N Engl J Med. Mar 4 1982;306(9):506-10. [Medline].

  15. [Best Evidence] Malviya M, Ohlsson A, Shah S. Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants. Cochrane Database Syst Rev. Jan 23 2008;CD003951. [Medline].

  16. Mullins CE, Pagotto L. Patent ductus arteriosus. In: The Science and Practice of Pediatric Cardiology. Lippincott Williams & Wilkins; 1997:1181-98.

  17. Ramsay JM, Murphy DJ Jr, Vick GW 3rd, et al. Response of the patent ductus arteriosus to indomethacin treatment. Am J Dis Child. Mar 1987;141(3):294-7. [Medline].

  18. Rashkind WJ, Mullins CE, Hellenbrand WE, Tait MA. Nonsurgical closure of patent ductus arteriosus: clinical application of the Rashkind PDA Occluder System. Circulation. Mar 1987;75(3):583-92. [Medline].

  19. Reller MD, Colasurdo MA, Rice MJ, McDonald RW. The timing of spontaneous closure of the ductus arteriosus in infants with respiratory distress syndrome. Am J Cardiol. Jul 1 1990;66(1):75-8. [Medline].

  20. Van Overmeire B, Smets K, Lecoutere D, et al. A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus. N Engl J Med. Sep 7 2000;343(10):674-81. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

patent ductus arteriosus, patent arterial duct, PDA, congenital heart defect, aorticopulmonary shunt, aorticopulmonary communication, ductus arteriosus, pulmonary hypertension, respiratory distress syndrome, congestive heart failure, rubella, fetal alcohol syndrome

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Steven R Neish, MD, SM, Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine
Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association
Disclosure: Nothing to disclose.

Medical Editor

Christopher Johnsrude, MD, Associate Professor of Pediatrics, Director of Electrophysiology, University of Louisville School of Medicine; Consulting Staff, Pediatric Cardiology Associates, PSC
Christopher Johnsrude, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Cardiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Hugh D Allen, MD, Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine
Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Gilbert Z Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center
Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD, Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin
Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

RELATED EMEDICINE ARTICLES
RELATED MEDSCAPE ARTICLES
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.