Imaging Findings of Patent Ductus Arteriosus.pptx

Cardiac imaging of patent ductus arteriosus

1. PATENT DUCTUS ARTERIOSUS JEMIMAH S. BUSTAMANTE-BELTRAN, MD 1 ST YEAR, QMMC-DRS JANUARY 16, 2021

2. OUTLINE Embryology Fetal Circulation Histology and Mechanisms of Closure Pathophysiology Clinical Features, Imaging, and Treatment

3. Patent D uctus A rteriosus (PDA) V ascular structure that connects the proximal descending aorta to the roof of the main pulmonary artery

4. EMBRYOLOGY Distal portion of the left sixth arch persists as the ductus arteriosus

5. Fetal Circulation I mportant for maintaining parallel circulation: ductus venosus foramen ovale ductus arteriosus

6. Histology and Mechanisms of Normal Closure M edia - longitudinally and spirally arranged layers of smooth muscle fibers within loose, concentric layers of elastic tissue Intima - thickened and irregular, with abundant mucoid material

7. Histology and Mechanisms of Normal Closure Fetal patency of the ductus arteriosus is controlled by: R elatively low fetal oxygen tension C yclooxygenase-mediated products of arachidonic acid metabolism

8. Transition al Circulation M echanical expansion of the lungs and an increase in arterial oxygen pressure result in a rapid decrease in pulmonary vascular resistance

9. Histology and Mechanisms of Normal Closure After birth, medial smooth muscle fibers in the ductus arteriosus contract Complete closure usually occurs within 24 to 48 hours of birth

10. Histology and Mechanisms of Normal Closure N ext 2 to 3 weeks, infoldings of the endothelium along with subintimal disruption and proliferation result in fibrosis and a permanent seal- ligamentum arteriosum

11. Incidence 1 in 2000 births for term neonates; 5% to 10% of all congenital heart disease Female to male ratio is 2:1

12. Anatomy The ductus arteriosus may persist in a wide variety of sizes and configurations

13. CONICAL

14. WINDOW

15. TUBULAR

16. COMPLEX

17. ELONGATED

18. Pathophysiology

19. Pathophysiology Left-to-right shunting results in pulmonary overcirculation and left heart volume overload Pulmonary edema is uncommon but may occur in older patients

20. CLINICAL FEATURES

21. Physical Examination H allmark physical finding is a continuous murmur, located at the upper left sternal border- “machinery” murmur prominent or bounding peripheral pulses Acyanotic

22. Chest Radiograph May be completely normal or it may demonstrate cardiomegaly with increased pulmonary vascular markings

23. Electrocardiogram Demonstrate sinus tachycardia or atrial fibrillation, left ventricular hypertrophy, and left atrial enlargement in patients with moderate or large ductus shunts

24. Echocardiogram C onfirm the diagnosis and to characterize a PDA Color Doppler is a modality used to estimate the degree of ductal shunting

25. CT Angiogram Narrow caliber patent ductus arteriosus

26. Cardiac Catheterization Therapeutic catheterization is currently the treatment of choice at most centers for most children and adults

27. END