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Pathology
When the ductus arteriosus closes after birth, the ductal tissue surrounds the
aorta and causes narrowing/obstruction of the aorta; often distal to origin of left subclavian artery
Aetiology
Commoner in girls, associated with Turners Syndrome, bicuspid aortic valve,
patent ductus arteriosus, Berry aneurysm or transposition of the great arteries
Signs
Hypertension, ejection systolic murmur radiating to the interscapular region,
radio femoral delay, left ventricular hypertrophy and differences in systolic blood
pressure between right and left arms
Symptoms
Failure to thrive, heart failure, dyspnoea, headache, epistaxis, claudication
Investigations
Antenatal ultrasound: Antenatal diagnosis may be
ECG: Right ventricular hypertrophy
Chest X-Ray: May be normal, signs of heart failure, cardiomegaly and notching
of ribs from erosion by collateral vessel formation.
Echo: Assess for structural abnormality and confirm defect
Classification: Classified by the relationship to the remnant of the ductus
arteriosus, ligamentum arteriosum and insertion into the aorta:
Pre-Ductal – Most common
Ductal
Post-Ductal
Treatment
Medical: Resuscitation and prostaglandins to keep the duct patent
Surgical: Percutaneous transcatheter balloon dilatation and stenting
Prognosis
Mortality from untreated defects or hypertension is high
Premature coronary artery disease, congestive cardiac failure, hypertensive
encephalopathy
Key Facts
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Key Images
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Key References
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