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Patent ductus arteriosus

icanis

Synonym(s): PDA; Ductus


Introduction

  • Common congenital disease in many breeds. Hereditary in experimental colony of Miniature Poodles in the USA.
  • Fetal communication between aorta and pulmonary artery fails to close at birth.
  • Signs: spectrum from asymptomatic murmur to left congestive heart failure, continuous, waxing and waning - 'machinery murmur' (pathognomonic).
  • Diagnosis: signs, ultrasonography.
  • Treatment: surgical correction before symptomatic.
  • Prognosis: good if corrected, guarded without surgery.
    Print off the owner factsheet Congenital heart disease - patent ductus arteriosus to give to your client.

Pathogenesis

Etiology

  • Failure of normal ductal muscle development which prevents physiologic or functional closure at birth.

Predisposing factors

General
  • Breed.
  • Sex.

Pathophysiology

  • The ductus arteriosus, a normal fetal vessel, fails to close in the first hours or days after birth → conduit between the descending aorta and the pulmonary trunk.

Typical
  • Pulmonary vascular resistance much lower than systemic vascular resistance so:
    • Left to right shunt (aorta to pulmonary artery) → increased flow through pulmonary vasculature → increased return to left heart → volume overload of left heart → chronic left-sided CHF.
    • Dilation and eccentric hypertrophy of left atrium/ventricle can result in mitral regurgitation (MR) due to stretching of the mitral annulus.
    • Myocardial failure (mild-moderate) Heart: myocarditis is common, especially in large breeds.

    Rare
  • Right-to-left shunt.
  • Pulmonary hypertension Pulmonary Arterial Hypertension (PHT) due to retention of fetal type pulmonary vasculature and/or massive pulmonary overcirculation with a left-right shunt resulting in reactive hypertension (a left-to-right shunt typical of PDA) → pulmonary overcirculation → pulmonary hypertension (as Eisenmenger's physiology) Eisenmenger's complex → right-left shunt.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Campbell F E, Thomas W P, Miller S J, Berger D & Kittleson M D (2006) Immediate and late outcomes of transarterial coil occlusion of patent ductus arteriosus in dogs. J Vet Intern Med 20 (1), 83-96 PubMed.
  • Bureau S, Monnet E & Orton E C (2005) Evaluation of survival rate and prognostic indicators for surgical treatment of left-to-right patent ductus arteriosus in dogs: 52 cases (1995-2003). JAVMA 227 (11), 1794-1799 PubMed.
  • Côté E & Ettinger S J (2001) Long term clinical management of right-to-left ("reversed") patent ductus arteriosus in 3 dogs. JVIM 15 (1), 39-42 PubMed.
  • Moore K W & Stepien R L (2001) Hydroxyurea for treatment of polycythemia secondary to right-to-left shunting patent ductus arteriosus in 4 dogs. J Vet Intern Med 15 (4), 418-421 PubMed.
  • van Israël N, French A T, Wotton P R & Wilson N (2001) Hemolysis associated with patent ductus arteriosus coil embolization in a dog. JVIM 15 (2), 153-156 PubMed.
  • Corti L B, Merkley D et al (2000) Retrospective evaluation of occlusion of patent ductus arteriosus with hemoclips in 20 dogs. JAAHA 36 (6), 548-555 PubMed.
  • Fellows C G, Lerche P, King G & Tometzki A (1998) Treatment of patent ductus arteriosus by placement of two intravascular embolisation coils in a puppy. JSAP 39 (4), 196-199 PubMed.
  • Gavaghan B J, Lapointe J M & Thomas W P (1998) Acute onset of pulmonary necrotising arteritis in a dog with a left-to-right patent ductus arteriosus. Aust Vet J 76 (12), 786-791 PubMed.

Other sources of information

  • Fox, Sisson & Moise (1999) EdsTextbook of Canine and Feline Cardiology.2nd edn. Saunders C. pp 533, reference # 169a-169b.

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