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(Circulation. 2006;114:1873-1882.)
© 2006 American Heart Association, Inc.

Congenital Heart Disease for the Adult Cardiologist

Patent Ductus Arteriosus

Douglas J. Schneider, MD; John W. Moore, MD, MPH

From the University of Illinois College of Medicine at Peoria and Cardiac Catheterization Laboratory, Children’s Hospital of Illinois, Peoria, Ill (D.J.S.); and University of California at San Diego and Rady’s Children’s Hospital, San Diego (J.W.M.).

Correspondence to Douglas J. Schneider, MD, Clinical Associate Professor of Pediatrics, University of Illinois College of Medicine at Peoria, Director, Cardiac Catheterization Laboratory, Children’s Hospital of Illinois, 420 NE Glen Oak Ave, Suite 304, Peoria, IL 61603. E-mail djs@pedcard.com

Key Words: ductus arteriosus, patent • heart defects, congenital • heart diseases

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The patent ductus arteriosus (PDA) is a vascular structure that connects the proximal descending aorta to the roof of the main pulmonary artery near the origin of the left branch pulmonary artery. This essential fetal structure normally closes spontaneously after birth. After the first few weeks of life, persistence of ductal patency is abnormal. The physiological impact and clinical significance of the PDA depend largely on its size and the underlying cardiovascular status of the patient. The PDA may be "silent" (not evident clinically but diagnosed incidentally by echocardiography done for a different reason), small, moderate, or large. Regardless of the size, complications may arise, and it is important for both pediatric and adult cardiologists to have an understanding of the pathophysiology, clinical implications, and management of PDA.

	Embryology

 
The ductus arteriosus is a normal and essential fetal structure that becomes abnormal if it remains patent after the neonatal period. In normal cardiovascular development, the proximal portions of the sixth pair of embryonic aortic arches persist as the proximal branch pulmonary arteries, and the distal portion of the left sixth arch persists as the ductus arteriosus, connecting the left pulmonary artery with the left dorsal aorta (Figure 1). Normally, the distal right sixth aortic arch loses its connection to the dorsal aorta and degenerates. This transformation is complete by 8 weeks of fetal life.

View larger version (26K): [in this window] [in a new window]   Figure 1. Schematic of embryonic aortic arch system. The 6 pairs of embryonic aortic arches are demonstrated (left-sided arches are numbered). The portions that normally . . . [Full Text of this Article]

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