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Common Congenital Heart Lesions - page 5 / 126





5 / 126

5 of 126

3. Patent Ductus Arteriosus

Clinical Presentation: small PDA= asymptomatic, large PDA= CHF (tachycardia, poor feeding, slow growth, recurrent lower resp. tract infections). Moderate PDA: presents as teenager or adult with fatigue, dyspnea, palpitations or Afib., watch out for infection

Physical Findings:

  • 1.

    CONTINUOUS, machine-like murmur at left subclavicular region

  • 2.

    If pulm. vascular disease, then murmur shortens due to decreased pressure

gradient between systole and diastole 3. Cyanosis and clubbing if Eisenmenger syndrome is present

Diagnostic Imaging and Testing: A. Chest x-ray: enlarged cardiac silhouette with large PDA (LA and LV enlargement), calcification of ductus can be seen in adults

  • B.

    ECG: LA enlargement, LVH

  • C.

    Echo+ Doppler: visualize PDA, look at flow and right heart pressure

  • D.

    Cardiac Cath: Nope. However, it will show higher blood O2 in PA than in RV

  • E.

    Angiography: abnormal flow through PDA

Treatment: Prostaglandin synthesis inhibitors to close PDA in most patients, PDAs rarely close spontaneously. Can be corrected surgically

Etiology: Ductus arteriosus connects left pulmonary artery to ascending aorta, PDA occurs when ductus fails to close.

Pathology: LA and LV dilation

Pathophysiology: magnitude of flow through PDA depends on cross-sectional area and length of ductus and resistance of systemic and pulmonary vasculatures. During fetal life, blood goes from pulmonary artery to aorta. After birth, blood flow reverses direction, resulting in a left to right shunt. Volume overload in Pulm circulation, LA, and LV, causing dilatation and left-sided heart failure. Right heart is only involved if patient has pulm vas. disease. Eisenmenger’s results in cyanosis in feet with sparing of upper extremities

Epidemiology: 1/2500-5000 live births. Risk factors: 1st infection, prematurity, birth at high altitude

trimester maternal rubella

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