Patent Ductus Arteriosus.

Management of Patent Ductus Arteriosus in the Adult Population.

Patent ductus arteriosus (PDA) is defined as a persistent communication between the pulmonary artery and the aorta that normally closes before birth. While the ductus arteriosus is an essential vascular shunt for a developing fetus, its failure to close can become pathologic. Most PDAs are repaired during infancy; however, some remain patent into adulthood, with presentations varying in clinical severity. Untreated PDA can lead to significant morbidity, with complications including left-heart volume overload, arrhythmia, pulmonary hypertension, and possible Eisenmenger syndrome. This review covers the management of PDA in adults, highlighting the pathophysiology, morphological classification, clinical presentation, and current approaches to closure. Transcatheter closure is currently the preferred approach, although surgical methods may be used in patients with distinct anatomy or other concomitant intracardiac pathology. While both methods come with different risk profiles, closure in adults has proven to be effective, resulting in considerable hemodynamic and clinical improvements.

Prevalence and Predictors of Patent Ductus Arteriosus on Day 3 and Day 7 in Preterm Neonates: A Prospective Observational Study

Lower gestational age and lower birth weight were significantly associated with persistence of PDA, indicating prematurity as a major determinant, highlighting PDA as a prevalent condition contributing significantly to early complications and death.

Neonatal acute kidney injury and the patent ductus arteriosus.

Patent Ductus Arteriosus Recanalization in Tricuspid Atresia with Restrictive Ventricular Septal Defect and Moderate Pulmonary Valve Stenosis: A Minimally Invasive Strategy in a Critical Case

Background : Tricuspid Atresia (TA) is a severe cyanotic Congenital Heart Disease (CHD) characterized by the absence of the tricuspid valve, resulting in Right Ventricular (RV) hypoplasia and dependence on interatrial and extracardiac shunts for pulmonary blood flow. In cases of restrictive Ventricular Septal Defect (VSD) with pulmonary outflow tract obstruction, the pulmonary circulation becomes duct-dependent. Closure of the Patent Ductus Arteriosus (PDA) may therefore lead to life-threatening hypoxemia. Prostaglandin E1 (PGE1) infusion is commonly used to maintain ductal patency; however, in emergency situations where PGE1 is unavailable or ineffective, catheter-based PDA recanalization can serve as a minimally invasive rescue strategy. Case Illustration : A 4-month-old female with known TA presented with progressive cyanosis and respiratory distress. Echocardiography demonstrated TA, hypoplastic RV, large Atrial Septal Defect (ASD), restrictive VSD, and a ductal tunnel without detectable flow. After initial stabilization, the patient developed recurrent severe desaturation below 70% despite maximal medical and ventilatory support. Urgent cardiac catheterization revealed a functionally closed PDA. Recanalization was successfully performed using balloon dilatation followed by implantation of a 4.0 × 20 mm drug-eluting stent, restoring pulmonary blood flow and improving oxygen saturation from 55% to 91%. Conclusion : PDA recanalization with stent implantation is a viable and life-saving minimally invasive option in critically ill patients with duct-dependent CHD when pharmacologic support fails and may serve as a bridge to staged surgical palliation.

Clinical and Pathophysiological Interplay Between Patent Ductus Arteriosus and Patent Foramen Ovale: A Comparative Narrative Review

ABSTRACT Background Patent ductus arteriosus (PDA) and patent foramen ovale (PFO) are two fetal cardiovascular shunts that normally undergo functional and anatomical closure shortly after birth. While PDA is a well‐recognized congenital defect in veterinary cardiology, the haemodynamic interaction between PDA and PFO has received little attention, particularly in neonates. Objectives To review the physiological and pathophysiological relationship between PDA and PFO and evaluate available evidence from veterinary and comparative human literature. Review Content Increased pulmonary blood flow and secondary pulmonary hypertension associated with PDA may alter right‐sided cardiac pressures and predispose affected neonates to persistent or reopened PFO, potentially resulting in interatrial shunting and cyanosis. PDA represents one of the most prevalent congenital cardiac defects encountered in canine medicine and constitutes a substantial proportion of congenital heart diseases in dogs. Conversely, PFO appears to be less frequently recognized in veterinary patients, likely because many affected animals remain clinically asymptomatic. In human medicine, persistence of the foramen ovale has been identified in approximately one‐quarter of the adult population. This narrative review summarizes the physiology and pathophysiology of ductus arteriosus and foramen ovale closure, analyses the mechanisms by which PDA can influence FO patency, and discusses relevant evidence from both veterinary and human literature. Conclusions Although no clearly documented veterinary case of concurrent PDA and PFO has been identified, comparative evidence suggests that secondary pulmonary hypertension may play an important role in this interaction. Improved understanding of this relationship may enhance diagnostic accuracy and management strategies in neonatal animals.

Accidental Balloon Dilatation of Patent Ductus Arteriosus in A Case of Critical Coarctation of Aorta: Subsequently A New Innovation for Patent Ductus Arteriosus Dependent Circulation

Coarctation of the aorta is a rare form of congenital heart disease, though preductal co-arctation is not very uncommon. This is a report on a 28-days-old girl who was referred to our center for evaluation. Doppler echocardiography showed severe preductalcoarctation of aorta and a tiny Patent DuctusArteriosus (PDA). Later it was confirmed by aortogram which showed critical coarctation of aorta (COA). This full-term infant with symptomatic COA was treated successfully with a Balloon angioplasty procedure. But during last inflation, wire entered through PDA to the pulmonary artery and was dilated with 8×3 Tyshak mini balloon considering balloon placement in Coarctation segment. Aortogram showed a large PDA after balloon dilatation. Immediately patient developed some features of heart failure. Patient was referred to cardiac surgeon as device closure was not possible in such a large PDA in a tiny newborn with maximum size Piccolo device. Subsequently balloon dilatation of PDA was found effective in maintaining circulation to pulmonary tree in PDA dependent cases. Chest Heart J. 2023; 47(2) : 141-145