Clinical Data: 35 year male with dyspnoea shows on CXR prominent pulmonary bay with RV type of cardiomegaly with CT angiography showing prominent communicating channel between aorta (distal to left subclavian) and dilated MPA (33mm), pulmonary tree in general (pulmonary hypertension) ,with right ventricular & right atrial enlargement , consistent with Patent ductus arteriosus with no other associated anomalies.
Teaching points by Dr MGK Murthy, Dr GA Prasad
CT Technician: Mr Venkat
1.Isolated PDA uncommon (10-12% of all CHD)
2.Soon after birth , when hemodynamics change , PDA occludes (if auscultated as continuous machinery murmur after 3 months , could lead to Extra cardiac type of Left to right shunt and sequel)
3. Is therapeutic when associated in ,hypoplastic left heart syndrome/transposition of great vessels /pulmonary atresia.
4. CXR findings range from comma type calcification in aorto- pulmonary window (in occluded ligamentum arteriosus variety) to right ventricular/ atrial cardiomegaly and congestive cardiac failure in severe hemodynamic varieties
5.varies in length( long or short), straight or tortuous, wider on the aortic side and shows acute angle with aorta (if isolated PDA) and obtuse angle (if associated with other anomalies)
6. Complications include Aortic rupture / Eisenmenger physiology /Left heart failure / Pulmonary hypertension/ Myocardial ischemia etc.
7. Treatment depends on hemodynamic severity, including management of endocarditis/catheter closure or ligation procedures ( IV indomethacin /Ibuprofen within 2 weeks of life could sclerose the ductus)