Friday, March 31, 2023

Patent Ductus Arteriosus (PDA)


Patent ductus arteriosus (PDA), in which there is a persistent communication between the descending thoracic aorta and the pulmonary artery that results from failure of normal physiologic closure of the fetal ductus (see image below), is one of the more common congenital heart defects.

Schematic diagram of a left-to-right shunt of bloo

Schematic diagram of a left-to-right shunt of blood flow from the descending aorta via the patent ductus arteriosus (PDA) to the main pulmonary artery.

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The patient presentation of patent ductus arteriosus (PDA) varies widely. Although frequently diagnosed in infants, the discovery of this condition may be delayed until childhood or even adulthood. In isolated patent ductus arteriosus (PDA), signs and symptoms are consistent with left-to-right shunting. The shunt volume is determined by the size of the open communication and the pulmonary vascular resistance (PVR).

Patent ductus arteriosus (PDA) may also exist with other cardiac anomalies, which must be considered at the time of diagnosis. In many cases, the diagnosis and treatment of a patent ductus arteriosus (PDA) is critical for survival in neonates with severe obstructive lesions to either the right or left side of the heart.

Historical information

Galen initially described the ductus arteriosus in the early first century. Harvey undertook further physiologic study in fetal circulation. However, it was not until 1888 that Munro conducted the dissection and ligation of the ductus arteriosus in an infant cadaver, and it would be another 50 years before Robert E. Gross successfully ligated a patent ductus arteriosus (PDA) in a 7-year-old child.
This was a landmark event in the history of surgery and heralded the true beginning of the field of congenital heart surgery. Catheter-based closure of the structure was first performed in 1971.

See also Patent Ductus Arteriosus Surgery and Eisenmenger Syndrome.

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