Radiofrequency valvotomy and balloon dilation is more efficacious and safe compared with closed pulmonary valvotomy and BT shunt in selected patients with PA-IVS.

No abstract

A clinically undetectable, small ductus arteriosus was identified by Doppler ultrasonography in 21 individuals. Infants were excluded from the study and no patient had pulmonary hypertension. Persistence of the ductus arteriosus is likely to be more common than shown by less sensitive diagnostic methods. Some patients considered to have infective endocarditis with a normal heart may have a silent ductus arteriosus. Evidence of such an association would justify ligation or antibiotic cover as prophylactic measures. The classic continuous murmur of ductus arteriosus is usually sufficient in itself to lead to surgical closure being undertaken. However, the murmur may be atypical in infancy or in the presence of pulmonary hypertension or a large shunt. 1-3 The term "silent duct" was coined to describe the preterm infant with respiratory distress syndrome in whom the ductul murmur is not heard.4 Doppler ultrasonography has led to the recognition of a small ductus arteriosus with normal pulmonary artery pressure which cannot be identified clinically.We report our experience in identifying such a "silent duct" in 21 patients examined clinically and by ultrasonography over a three year period. Patients and methods Because of reported difficulties in duct recognition in infants3 the patients reported on were all more than 12 months old.We considered that the description of "silent duct" was justified when there was: