The ductus arteriosus (DA) is a fetal blood vessel connecting the left pulmonary artery Pulmonary artery The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. Lungs: Anatomy to the aorta Aorta The main trunk of the systemic arteries. Mediastinum and Great Vessels: Anatomy. The DA allows blood to bypass pulmonary circulation Circulation The movement of the blood as it is pumped through the cardiovascular system. ABCDE Assessment. After birth, the DA remains open for up to 72 hours and then constricts and involutes, becoming the ligamentum arteriosum Ligamentum arteriosum Prenatal and Postnatal Physiology of the Neonate. Failure of this process to occur results in patent ductus arteriosus (PDA), a condition that causes up to 10% of congenital Congenital Chorioretinitis heart defects. Patent ductus arteriosus is twice as common in girls (especially premature infants Premature infants A human infant born before 37 weeks of gestation. Sudden Infant Death Syndrome (SIDS)) and causes a continuous machinery-like murmur on clinical examination. Patent ductus arteriosus may be associated with other cardiac Cardiac Total Anomalous Pulmonary Venous Return (TAPVR) defects; an echocardiogram Echocardiogram Transposition of the Great Vessels can confirm the diagnosis. Treatment aims at closure of the remnant structure either through pharmacological or surgical means.
Last updated: 7 Sep, 2021
The ductus arteriosus (DA) is a fetal blood vessel connecting the left pulmonary artery Pulmonary artery The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. Lungs: Anatomy to the aorta Aorta The main trunk of the systemic arteries. Mediastinum and Great Vessels: Anatomy, bypassing the pulmonary circulation Circulation The movement of the blood as it is pumped through the cardiovascular system. ABCDE Assessment. Failure of the vessel to close and involute within 72 hours of birth results in a condition called patent ductus arteriosus (PDA).
The DA:
The DA is a fetal blood vessel connecting the
aorta
Aorta
The main trunk of the systemic arteries.
Mediastinum and Great Vessels: Anatomy (usually at the arch) to the left
pulmonary artery
Pulmonary artery
The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs.
Lungs: Anatomy. When this vessel persists after birth, it is termed PDA.
The severity of symptoms depends primarily on the degree of L-R shunt, which is dictated by size and length of the defect.
Degree of shunt | Clinical presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor | Physical examination |
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Small shunt |
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Murmur:
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Moderate shunt |
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Large shunt | Infant:
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Phonocardiograms of abnormal
heart sounds
Heart sounds
Heart sounds are brief, transient sounds produced by valve opening and closure and by movement of blood in the heart. They are divided into systolic and diastolic sounds. In most cases, only the first (S1) and second (S2) heart sounds are heard. These are high-frequency sounds and arise from aortic and pulmonary valve closure (S1), as well as mitral and tricuspid valve closure (S2).
Heart Sounds caused by the following
cardiac
Cardiac
Total Anomalous Pulmonary Venous Return (TAPVR) defects:
aortic
regurgitation
Regurgitation
Gastroesophageal Reflux Disease (GERD),
mitral valve prolapse
Mitral valve prolapse
Abnormal protrusion or billowing of one or both of the leaflets of mitral valve into the left atrium during systole. This allows the backflow of blood into left atrium leading to mitral valve insufficiency, systolic murmurs, or cardiac arrhythmia.
Mitral Valve Prolapse, mitral
stenosis
Stenosis
Hypoplastic Left Heart Syndrome (HLHS) (
MS
MS
Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease that leads to demyelination of the nerves in the CNS. Young women are more predominantly affected by this most common demyelinating condition.
Multiple Sclerosis), aortic
stenosis
Stenosis
Hypoplastic Left Heart Syndrome (HLHS) (AS), tricuspid
regurgitation
Regurgitation
Gastroesophageal Reflux Disease (GERD), hypertrophic obstructive
cardiomyopathy
Cardiomyopathy
Cardiomyopathy refers to a group of myocardial diseases associated with structural changes of the heart muscles (myocardium) and impaired systolic and/or diastolic function in the absence of other heart disorders (coronary artery disease, hypertension, valvular disease, and congenital heart disease).
Cardiomyopathy: Overview and Types (HOCM),
atrial septal defect
Atrial Septal Defect
Atrial septal defects (ASDs) are benign acyanotic congenital heart defects characterized by an opening in the interatrial septum that causes blood to flow from the left atrium (LA) to the right atrium (RA) (left-to-right shunt).
Atrial Septal Defect (ASD) (
ASD
ASD
Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by poor social skills, restricted interests/social interactions, and repetitive/stereotyped behaviors. The condition is termed a “spectrum” because of the wide variability in the severity of symptoms exhibited.
Autism Spectrum Disorder),
ventricular septal defect
Ventricular Septal Defect
Tetralogy of Fallot (VSD), and patent ductus arteriosus (PDA)
Echocardiogram
Echocardiogram
Transposition of the Great Vessels showing PDA:
An
echocardiogram
Echocardiogram
Transposition of the Great Vessels depicting PDA with a small shunt (white arrow) found incidentally in a patient with
Kawasaki disease
Kawasaki disease
An acute, febrile, mucocutaneous condition accompanied by swelling of cervical lymph nodes in infants and young children. The principal symptoms are fever, congestion of the ocular conjunctivae, reddening of the lips and oral cavity, protuberance of tongue papillae, and edema or erythema of the extremities.
Kawasaki Disease
Continuous murmur of PDA should be differentiated from: