The document discusses a patent ductus arteriosus (PDA), which is a persistent opening between the aorta and pulmonary artery that normally closes soon after birth. A PDA allows blood to flow from the aorta back to the pulmonary artery, creating a left-to-right shunt. Over time, the excess blood flow can cause the pulmonary arteries to remodel, potentially leading to pulmonary hypertension and even a reversed, right-to-left shunt. Echocardiography can be used to determine the size of the opening, degree of shunting, and pulmonary artery pressure in patients with a PDA.

1. PATENT
DUCTUS
ARTERIOSUS
MADE BY :- Muskan Kapoor

2. INTRODUCTION
● Ductus arteriosus is a communication channel between aorta and pulmonary
artery during fetal life.
● Normally it closes soon after birth as the child cries and expansion of lungs occurs.
● If it fails to do so, then it is called persistent (patent) ductus arteriosus .
● Through this ductus , the blood flows from a high pressure vessel (aorta) to a low
pressure vessel (pulmonary artery). This is called left to right shunt .
● The pressure gradient between aorta and pulmonary artery is maintained
throughout the systole and beginning of diastole, hence, blood flow is continuous.
● As much as 50% of the ventricular output is re circulated through the lungs .

3. CLINICAL FEATURES
● Small shunts may not produce
symptoms for years.
● Large shunts may produce
retardation of growth and
development.
● Children may complain of cough
and breathlessness

4. CLINICAL SIGNS
● Pulses are increased in volume and
pulse pressure may be wide.
● A continuous murmur at left second
intercostal space
● Thrill at second left intercostal space
may be palpable.
● Enlargement of pulmonary artery
● Increased pulmonary artery pulsation
on fluoroscopy.
● ECG may be normal or may show left
ventricular hypertrophy.

5. PDA WITH REVERSE SHUNT
● So far the gradient between aorta and pulmonary artery occurs, the shunt remains
left to right but over the years, progressive large amount of blood flow through the
pulmonary vessels leads to permanent changes in these vessels with subsequent
development of pulmonary hypertension.
● In spite of pulmonary hypertension, the gradient remains still left to right till a
stage comes when pulmonary pressure becomes high and equal to aorta or may
even increase, in such a situation, the shunt first becomes bidirectional and then
from right to left. This type of shunt produces cyanosis.

6. ECHOCARDIOGRAPHY
● It will help to know the size of defect ,
degree of shunt and PA pressure.
● A LA and aorta ratio greater than 1.3/1 is
considered to be reliable marker of
hemodynamically significant ductal shunt
and it is assess by continual equation.
● It will also help us to know wether LA and LV
are dilated due to increased venous return
from pulmonary circulation.

8. ● On color flow mapping in PSAX retrograde
mosaic jet of flow from the left pulmonary
artery to the dilated main pulmonary artery.