Patent ductus arteriosus-CT

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)