The Various Hemodynamic Profiles of the Patent Ductus Arteriosus in Adults

Abstract

The patent ductus arteriosus (PDA) has diverse clinical and hemodynamic manifestations depending on its size and the degree of the ensuing left-to-right shunt. A small PDA that causes minor shunting has no major hemodynamic consequences. Conversely, a large PDA with a significant left-to-right shunt may lead to various hemodynamic abnormalities. These include left-sided volume overload that may result in heart failure and/or pulmonary hypertension, the latter being a flow-dependent and mostly reversible phenomenon. The most feared complication is the development of severe and irreversible pulmonary hypertension (Eisenmenger physiology). In this manuscript, we provide examples of the various hemodynamic profiles of PDA as assessed by echocardiography in the adult population.

Multimodality Imaging of Patent Ductus Arteriosus Complicated by Severe Pulmonary Arterial Hypertension in a Pregnant Patient

“… 1 On the other extreme of the disease severity, large uncorrected PDAs can be complicated by left-sided volume overload and pulmonary hypertension (PH), which appears to be flow dependent and in some cases reversible. 2 Timely identification of CHD during pregnancy can prevent the development of adverse sequelae such as heart failure as well as Eisenmenger syndrome, a severe form of PH. Eisenmenger syndrome, originally described in patients with large ventricular septal defects, is seen in sustained left-to-right shunting and leads to pulmonary vasculature remodeling and subsequent right-to-left shunting reversal; it is observed in 3% of pregnant patients with CHD.…”

Surgical Treatment for Patent Ductus Arteriosus: Our Experience of 12 Years

“…Patent ductus arteriosus (PDA) is one of the most common congenital heart defects, particularly in premature births, constituting 5-10% of all congenital heart diseases [1][2]. If left untreated, it can lead to pulmonary hypertension, congestive heart failure, and death [3]. Also, complications like bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage are common, but these neonatal morbidities can be reduced significantly with early diagnosis and treatment [4].…”

Simultaneous treatment for acute type B intramural hematoma and patent ductus arteriosus in an adult using a covered stent

“…Most PDAs are mainly diagnosed in children, accounting for 6%-11% of all congenital heart diseases, and are rarely detected in adults. PDAs have diverse lengths, calibers, and shapes, all of which impact the degree of left-to-right shunt and corresponding hemodynamic consequences (4). A small PDA allows only a small left to right shunt, and is often clinically silent.…”