Persistent Patent Ductus Arteriosus

Abstract

Two observations about the ductus arteriosus are established: most normally developed infants will have a patent ductus arteriosus (PDA) at the time of delivery, and most fullterm infants will have anatomic obliteration of the ductus lumen by 3–6 months of age. Studies designed to determine how a PDA contributes to an infant's morbidity or when a PDA becomes a persistently patent ductus arteriosus have been hampered by the lack of consistent diagnostic criteria for defining the condition. Ellison et al. (22) attempted to evaluate several commonly used criteria for diagnosing a large leftto-right shunt through the ductus arteriosus by noting the occurrence of each sign both before and 36–48 hours after surgical ligation. No single criterion sufficed as an indicator of PDA. Certain signs, such as continuous murmur or hyperactive left ventricular impulse, were specific for a PDA, but lacked sensitivity; conversely, M-mode echocardiography and ventilatory support criteria were very sensitive but lacked specificity.