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ContentsSynopsisCodesDifferential Diagnosis & PitfallsBest TestsReferences
Emergency: requires immediate attention
Patent ductus arteriosus
Print
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Patent ductus arteriosus

Print Images (1)
Contributors: Mary Anne Morgan MD
Other Resources UpToDate PubMed

Synopsis

Patent ductus arteriosus (PDA) is a congenital heart defect characterized by the persistent opening of the ductus arteriosus resulting from failure to close after birth. PDA leads to blood from the aorta mixing with blood from the pulmonary artery. A patient with a small PDA may present with a heart murmur and no other obvious clinical symptoms. However, some patients may present with fast breathing, shortness of breath, poor feeding, poor weight gain, tiring easily, sweating while feeding, and poor growth.

PDA is a fairly common congenital heart disease more prevalent in females. The cause of PDA has not yet been identified. Some research indicates that genetic factors could be at play. PDA more commonly presents in infants who are premature or have neonatal respiratory distress syndrome. Infants with mothers who had rubella during pregnancy and patients with genetic disorders such as Down syndrome are at increased risk. PDA also commonly presents in infants with congenital heart problems, such as transposition of the great vessels, hypoplastic left heart syndrome, and pulmonary stenosis.

Small PDAs of premature infants may close on their own within the first 2 years of life. In premature infants, treatment is usually only required if the PDA is causing breathing issues or heart problems. In full-term infants, if the PDA is open after the first several weeks of life, it is unlikely to close on its own.

Patients with a small PDA that stays open may develop heart symptoms. Patients with a larger PDA may develop complications such as heart failure, pulmonary hypertension, or endocarditis if the PDA does not close.
    
If the patient has no other heart defects, the aim of treatment is usually to close the PDA. If the patient has other existing heart defects, keeping the ductus arteriosus may be lifesaving. Treatment options include medications, catheter-based procedures, and surgical procedures.

For more information, see OMIM.

Codes

ICD10CM:
Q25.0 – Patent ductus arteriosus

SNOMEDCT:
83330001 – Patent ductus arteriosus

Differential Diagnosis & Pitfalls

Murmurs of infancy:
  • Ventricular septal defect – Typically high frequency, short systolic murmur but can be holosystolic harsh murmur if larger defect; usually becomes louder after the first several hours of life, as pulmonary vascular resistance decreases.
  • Peripheral pulmonary stenosis – Quiet, midsystolic ejection murmur; usually resolves by 6-12 months.
  • Tricuspid regurgitation – Can be seen as part of tricuspid atresia, pulmonary atresia, and Ebstein anomaly. Murmur is holosystolic, "blowing."
  • Pulmonary stenosis – "Harsh" midsystolic ejection murmur loudest at right upper sternal border.
  • Aortic stenosis – Harsh midsystolic ejection murmur loudest at right upper sternal border, usually accompanied by systolic "click" and substernal systolic thrill.
  • Coarctation of aorta – Murmur usually heard posteriorly, between scapulae.
Murmurs in children >1 year:
  • Still's murmur – "Musical" systolic murmur without radiation.
  • Atrial septal defect – Subtle in children, often not detected until adulthood. Soft systolic murmur at the left upper sternal border, sometimes with diastolic murmur at lower left sternal border. Usually has fixed / split second heart sound (S2).
  • Mitral regurgitation – Holosystolic murmur that radiates to the apex. Associated with other illnesses or from anomalies in coronary vasculature or collagen vascular disease.
  • Bicuspid aortic valve – Most common congenital heart lesion. Early, holosystolic ejection click at the apex, sometimes with aortic stenosis / murmur and or aortic regurgitation.

Best Tests

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References

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Last Updated: 03/29/2017
Copyright © 2018 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Patent ductus arteriosus
Print 1 Images
Patent ductus arteriosus : Fatigue, Exertional dyspnea, Failure to thrive, Heart murmur, HR increased, RR increased
Copyright © 2018 VisualDx®. All rights reserved.