Patent ductus arteriosus differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief:Cafer Zorkun, M.D., Ph.D. [2]; Keri Shafer, M.D. [3] Priyamvada Singh, MBBS[4] Assistant Editor-In-Chief: Kristin Feeney, B.S. [5]

Differentiating Patent Ductus Arteriosus from other Diseases

Patent ductus arteriosus should be differentiated from other conditions producing continuous murmur-

Venous Hum

  • Frequently heard in children over the base of the neck, usually best on the right side.
  • Changes with position. Disappears in the supine position or with compression.
  • Louder in diastole

Mammary Souffle

  • Heard during late pregnancy and the early postpartum period in lactating women.
  • Thought to be arterial in origin
  • Can be bilateral
  • Is louder, peaks in systole
  • Vanishes in the upright position
  • Abolishes by local compression

Aorticopulmonary Window

Rupture of the Sinus of Valsalva

  • It can rupture into a cardiac chamber. Almost always arise from the right or the noncoronary cusps and rupture into the RV and RA respectively. Occasionally is acquired as a result of endocarditis. Large acute perforations tend to occur between puberty and age 30 causing severe retrosternal chest pain, dyspnea related to the large left-to-right shunt. The murmur is louder in a lower parasternal position. People with VSDs and sudden development of chest pain have frequently experienced rupture of a coexistent sinus of valsalva aneurysm. A rupture of the sinus of valsalva can distort or compress the coronary arteries and cause an infarction, distort the conduction system, cause AV block, distort the aortic valve, and cause AS or AI. Patients with rupture of the sinus of valsalva, should undergo surgical correction because mortality is high within a year of rupture.

Fistulas of the Coronary Circulation

  • Generally a coronary artery that arises normally will communicate with the RV.
  • Occasionally drain into the pulmonary trunk.
  • The artery that forms the fistula is generally dilated, elongated, and tortuous. The left-to-right shunt is small.
  • It may not be recognized radiographically.
  • Patients with small fistula are generally asymptomatic. Therefore, no justification to repair it.
  • On the other hand, if the shunt is extremely large, then failure may develop in the 4th, 5th or 6th decade of life. It can be treated with ligation.

Anomalous Origin of the Coronary Artery from the Pulmonary Trunk

  • Usually refers to the origin of the left coronary artery from the pulmonary trunk.
  • Approximately, 80 to 90% of the patients die in their first year of life due to ischemia.
  • Blood from the high pressure RCA flows to the low pressure left coronary artery and the pulmonary artery.
  • Anomalous origin of the RCA from the PA is much rarer, but these patients stand a better chance of surviving into adulthood because it is less likely to cause ischemia early in life.

Pulmonary Arteriovenous Fistula

VSD and AR

Coarctation(Rarely)

References



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