Patent Ductus Arteriosus: Update Review

Abstract

The Ductus Arteriosus (DA) is a vascular structure of the fetal heart that communicates the isthmus of the aorta (at the junction of the aortic root with the descending aorta) to the roof of the bifurcation of the pulmonary trunk. It is an essential structure of the fetal heart that connects the pulmonary circulation to de systemic circulation bypassing the lungs. The DA is usually patent at birth. It undergoes through muscle contraction between 10 and 15 hours of life and closes due to fibrous proliferation of the intimal layer by the third week of life. The change in the natural history of DA, with consequent permeability beyond the predicted period, promotes the Patent Ductus Arteriosus (PDA) a congenital acyanotic heart disease. The most important risk factor for PDA is prematurity. Other risk factors are the congenital rubella, chromosomal abnormalities, genetic factors, low birth weight, perinatal asphyxia and birth in high altitude places. The clinical manifestations of a PDA are determined by the degree of left-to-right shunting, which is dependent upon age, the size and length of the PDA and the difference between pulmonary and systemic vascular resistances. The diagnosis of PDA is usually based on its characteristic clinical findings and confirmation by echocardiography. The proper management of PDA depend on age, hemodynamic impact and resource available and may include conservative management, pharmacologic treatment, surgical approach and percutaneous closure. The complication rates for percutaneous and surgical closure are rare.