Patent ductus arteriosus: The Daily PANCE Blueprint
A preterm infant born at 27 weeks has a continuous murmur at the left upper sternal border, bounding pulses, and wide pulse pressure. CXR with cardiomegaly with increased vascular congestion. Echocardiogram shows a 2.0mm ductal diameter with left-to-right shunting and left atrial enlargement. What is the most likely diagnosis?
A. Ventricular septal defect
B. Coarctation of the aorta
C. Patent ductus arteriosus
D. Pulmonary embolism
E. Neonatal sepsis
Answer and topic summary
The answer is C. Patent ductus arteriosus
Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. It is defined by the failure of the ductus arteriosus (DA) to close within 72 hours after birth. The DA’s role during pregnancy is to shunt blood away from the non-working fetal lungs (i.e., the DA allows blood to be carried from RV, bypass the lungs, go through the aorta, and eventually to the placenta where gas exchange will occur). Risk factors include preterm status, low birth weight, high altitudes, genetic factors, and in utero exposure to rubella. Clinical features include wide pulse pressure, murmur, bounding pulses, respiratory failure, acidosis, and hypotension. Management includes fluid restriction, pharmacological agents (COX inhibitors like indomethacin) or surgery.
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
Also covered as part of the Pediatric Rotation topic lists
