Doppler ultrasound and the silent ductus arteriosus.

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:

Pulmonary Endarteritis and Subsequent Pulmonary Embolism Associated with Clinically Silent Patent Ductus Arteriosus

“…We In the diagnosis of pulmonary embolism, lower arterial oxygen tension and D-dimer>500 ng/mL are important (7,8 (2,3,9,10 (11).…”

“…PDA has been reported in combination with pulmonary endarteritis, at an incidence of 0.45-1.0% a year (1).On the other hand, pulmonary endarteritis is rarely accompanied with silent PDA (2). It may be difficult to detect silent PDA because of inaudible murmur (3), if the heart is determined to be a normal size by chest X-ray. We had the rare opportunity to follow a case of pulmonary endarteritis and subsequent pulmonary embolism with clinically silent PDA that was confirmed by 3-dimensional CT.…”

The role of history of disease factors in the congenital heart disease in adults

“…The causes can be broadly grouped into four categories: single gene defects, chromosomal abnormalities, history of familial and disease factors and environmental factors. The patients with a history of cardiac surgery for complex congenital heart disease or the patients with a history of a ventricular septal defects in childhood should have long-term follow-up with a cardiologist dedicated to the management of patients with congenital heart disease [11,12].…”

Qué hacer frente a un Ductus Arterioso Persistente clínicamente silente

“…6 Si bien, ésta se asocia a DAP significativos, se ha reportado en casos silentes. 7,8 A favor de la terapia intervencional, se postula la mayor disponibilidad y seguridad de esta técnica.…”

“…Sin embargo, dada la baja incidencia de la endarteritis en estos pacientes, puede optarse por una conducta expectante. 1,6 La actuales guías de la Sociedad Americana de Cardiología sobre cardiopatías congénitas del adulto recomiendan el seguimiento cada 3-5 años en aquellos pacientes con DAP silentes (recomendación I, C) y consideran razonable su cierre percutáneo en pacientes asintomáticos con DAP pequeños (recomendación IIa, C). En estas guías no se menciona como indicación de cierre la prevención primaria de endarteritis.…”