PDA

Question 1

What is a PDA?

Answer 1

A persistent communication between the aorta and the pulmonary artery. May be isolated or can be associated with ASDs or VSDs.

Question 2

What is the typical presentation of a PDA?

Answer 2

Heart murmur with symptoms of a large left to right shunt – fatigue, dyspnea. If shunt is large and nonrestrictive, may present with Eisenmenger physiology (including cyanosis and clubbing).

Question 3

Besides the continuous machinery murmur, what are other exam findings in PDA?

Answer 3

• Wide pulse pressure (must be distinguished from hyperthyroidism and AI)
• Oxygen saturation in upper and lower extremities (with large PDA) because unoxygenated blood from the ductus enters the aorta distal to the left subclavian artery, causing cyanosis and clubbing of lower extremities.

Question 4

What is best window on echo to dx PDA?

Answer 4

PSAX with color doppler. Measure of transpulmonary gradient across the ductus with CW can estimate PA pressure.

Question 5

What are the 2 Class I indications for PDA closure (either surgically or percutaneously)?

Answer 5

• Left atrial and/or LV enlargement or if PAH is present, or in the presence of net left-to-right shunting
• Prior endarteritis

Question 6

When would surgical closure be considered?

Answer 6

• When the PDA is too large for device closure

- Distorted ductal anatomy precludes device closure (eg aneurysm or endarteritis)

Question 7

Class III

When should PDAs not be closed?

Answer 7

PDA closure is not indicated for patients with PAH and net

right-to-left shunt.