Disease of the Aorta

Abstract

Patent ductus arteriosus is a blood vessel connecting the proximal left pulmonary artery to the descending aorta just distal to the left subclavian artery. During fetal life, the ductus arteriosus is a vital structure that bypasses the pulmonary circulation. A persistent shunt that remains patent well after birth is usually managed either surgically or interventionally by device (mostly coils) implantation early in life. Most adult cases with patent ductus arteriosus are small or silent without clinical hemodynamic significance. Moderate-sized ductus with significant left-to-right shunt causes left heart enlargement, and some degree of pulmonary hypertension are rarely seen. Large ducts in adults usually result in Eisenmenger physiology with eventual right-to-left shunt that may not be easy to diagnose using echocardiography. These patients have distal (lower body) cyanosis and toe clubbing.