PDA

• Occurs in 5-10% of all CHD
• More common in females
• May present as systolic murmur in the pulmonic area
• Classic murmur is continuous “machinery” murmur
• Bounding pulses, wide pulse pressure, hyperactive precordium

Pathophysiology

• Left to right shunt from aorta to pulmonary artery throughout cardiac cycle
• Hemodynamics similar to VSD
• Bounding pulses due to diastolic “run-off” of blood from aorta

EKG

• Small to moderate PDA: normal or LVH
• Large PDA: CVH

CXR

• Cardiomegaly
• LA/LV enlargement
• Increased pulmonary vascular markings

Management

• Indomethacin in premature neonates
• surgical ligation
• Transcatheter closure
• Complications of surgery include injury to the recurrent laryngeal n., left phrenic n., or thoracic duct
• SBE prophylaxis until 6 mos after repair

CHLA Board Review 2005
Park MK. Pediatric Cardiology for Practictioners, 3rded. St. Louis,
 Mosby, 1996.