Persistierender Ductus arteriosus

Verschluss
Ductus arteriosus Botalli mit Clips sichtbar im Röntgenbild und in der Computertomografie zwischen dem Aortenbogen und im Truncus pulmonalis. Inzwischen (Röntgenbilder) auch Z.n. Implantation eines Portkathetersystems.
Wikipedia • CC BY-SA 4.0
Patent ductus
arteriosus diagnosis following dyspnoea crisis in a 22-year-old woman. Volume rendering images better depict the presence of a patent ductus arteriosus.
www.eurorad.org • CC by-nc-sa-4.0
Significant
incidental cardiac disease on thoracic CT: what the general radiologist needs to know. Oblique sagittal reformatted image showing a “tubular” type of PDA, which was an incidental finding in a 52-year male patient being worked up for pulmonary embolism. AO aorta, PA pulmonary artery. This study was ECG gated and was probably a “double rule out” study to evaluate for pulmonary embolism and Aortic disease
insightsimaging.springeropen.com • CC-by-4.0
Absent left
main pulmonary artery with patent ductus arteriosus. a) Coronal, b) Sagittal MIP and c) rotated 3D VRT images. The white arrow refers to a dilated patent ductus aretriosus. Note the absence of the left main pulmonary artery and right sided aortic arch.
www.eurorad.org • CC by-nc-sa-4.0
Preschooler
with a murmur. AP (left) and lateral (right) images from an angiogram with the catheter in the aortic arch shows simultaneous opacification of the aorta and the main pulmonary artery.The diagnosis was patent ductus arteriosus.
pediatricimaging.org • CC-by-nc-sa 4.0
Patent ductus
arteriosus diagnosis following dyspnoea crisis in a 22-year-old woman. A patent ductus arteriosus (arrow) was depicted connecting the origin of the descending aorta (DA) to the main pulmonary artery (PA). AA: ascending aorta
www.eurorad.org • CC by-nc-sa-4.0
Patent ductus
arteriosus diagnosis following dyspnoea crisis in a 22-year-old woman. A patent ductus arteriosus (arrow) was depicted connecting the origin of the descending aorta (DA) to the main pulmonary artery (PA). AA: ascending aorta
www.eurorad.org • CC by-nc-sa-4.0
Patent ductus
arteriosus diagnosis following dyspnoea crisis in a 22-year-old woman. Chest X-ray PA view shows an enlarged pulmonary artery.
www.eurorad.org • CC by-nc-sa-4.0
Absent left
main pulmonary artery with patent ductus arteriosus. CT pulmonary angiography, axial MIP image revealed oligemic left lung which is supplied with dilated intercostal arteries (yellow arrow).
www.eurorad.org • CC by-nc-sa-4.0
Patent ductus
arteriosus • Aortic tubular hypoplasia/preductal coarctation with large patent ductus arteriosus - Ganzer Fall bei Radiopaedia
Alayed, R. Aortic tubular hypoplasia/preductal coarctation with large patent ductus arteriosus. Case study, Radiopaedia.org. (accessed on 07 Nov 2022) https://doi.org/10.53347/rID-97904 • CC by-nc-sa 3.0 (modified)
Anamnestisch
offener Ductus arteriosus. In der Computertomographie sieht man nur noch eine kleine hyperdense Stelle am Ort des Ductus arteriosus. Ein Kontrastmittelübertritt von der schon kontrastierten Pulmonalarterie zur noch kaum kontrastierten Aorta descendens konnte nicht nachgewiesen werden.
Wikipedia • CC BY-SA 3.0
Newborn with
a murmur. CXR AP at 1 day of life (above) and 1 year of life (below) shows interval development of cardiomegaly and pulmonary vascular congestion.The diagnosis was patent ductus arteriosus.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant with
a murmurCXR AP shows mild cardiomegaly and pulmonary vascular congestion along with an extra soft tissue mass just to the left of the spine near the presumed position of the ductus arteriosus.The diagnosis was a ductus diverticulum in a patient with patent ductus arteriosus.
pediatricimaging.org • CC-by-nc-sa 4.0
Acyanotic
infant. AP image from a ventricular injection in an angiogram shows simultaneous opacification of the aorta and main pulmonary artery.The diagnosis was patent ductus arteriosus.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
an abnormal fetal echo. Axial CT with contrast of the heart (above), obtained in a venous phase, shows discontinuity of the ascending and descending aorta while the sagittal image (below right) shows a dilated patent ductus arteriosus reconstituting the descending aorta and the coronal image (below left) shows dextrocardia.The diagnosis was interrupted aortic arch supplied by a patent ductus arteriosus in a patient with dextrocardia.
pediatricimaging.org • CC-by-nc-sa 4.0
Absent left
main pulmonary artery with patent ductus arteriosus. CT pulmonary angiography, axial MIP image revealed dilatation of the pulmonary trunk and right main pulmonary artery. Note absence of arterial flow to the left lung
www.eurorad.org • CC by-nc-sa-4.0
Absent left
main pulmonary artery with patent ductus arteriosus. a) Coronal, b) Sagittal MIP and c) rotated 3D VRT images. The white arrow refers to a dilated patent ductus aretriosus. Note the absence of the left main pulmonary artery and right sided aortic arch.
www.eurorad.org • CC by-nc-sa-4.0
Absent left
main pulmonary artery with patent ductus arteriosus. a) Coronal, b) Sagittal MIP and c) rotated 3D VRT images. The white arrow refers to a dilated patent ductus aretriosus. Note the absence of the left main pulmonary artery and right sided aortic arch.
www.eurorad.org • CC by-nc-sa-4.0
Absent left
main pulmonary artery with patent ductus arteriosus. CT pulmonary angiography, axial MIP image revealed oligemic left lung with absent left pulmonary arterial supply. This is associated with increased right pulmonary vasculature.
www.eurorad.org • CC by-nc-sa-4.0
Remnant of a
non-patent ductus arteriosus mimicking traumatic thoracic aorta transection: a case report. Aortography showed an interruption (the so called "linear tear") of the normal contour of the thoracic aorta in the corresponding area. A protrusion of the aortic lumen in the inner curve of the aorta is indicating the disruption of the intima and beginning of a pseudoaneurysm. The preoperative evaluation of imaging was: "findings indicating a traumatic rupture of aortic isthmus".
cardiothoracicsurgery.biomedcentral.com • CC-by-2.0
Absent left
main pulmonary artery with patent ductus arteriosus. CT pulmonary angiography coronal reformatted image showing hypoplastic left lung with abnormally elevated left diaphragmatic copula. Dorsal scoliotic deformity with convexity to the left side noted.
www.eurorad.org • CC by-nc-sa-4.0
Patent ductus
arteriosus • Krichenko angiographic classification of patent ductus arteriosus (illustration) - Ganzer Fall bei Radiopaedia
Tatco, V. Krichenko angiographic classification of patent ductus arteriosus (illustration). Case study, Radiopaedia.org. (accessed on 07 Nov 2022) https://doi.org/10.53347/rID-51870 • CC by-nc-sa 3.0 (modified)
Patent ductus
arteriosus • Wet lung and pulmonary venous congestion in the context of patent ductus arteriosus and patent foramen ovale - Ganzer Fall bei Radiopaedia
Botz, B. Wet lung and pulmonary venous congestion in the context of patent ductus arteriosus and patent foramen ovale. Case study, Radiopaedia.org. (accessed on 07 Nov 2022) https://doi.org/10.53347/rID-87034 • CC by-nc-sa 3.0 (modified)
Former
premature newborn now term gestational age with a murmur. CXR AP shows cardiomegaly and increased pulmonary blood flow.The diagnosis was patent ductus arteriosus.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Patent ductus arteriosus or arteriosum (PDA) is a congenital cardiac anomaly where there is persistent patency of the ductus arteriosus, a normal connection of the fetal circulation between the aorta and the pulmonary arterial system that develops from the 6 aortic arch.

Epidemiology

Patent ductus arteriosus occurs in ~1 in 2000 full-term neonates with a F: M of 2:1 .

Clinical presentation

A large patent ductus arteriosus classically gives a loud continuous machine-like murmur.

Pathology

The ductus is a necessity in utero but usually undergoes functional closure 48 hours after birth. Patency of the ductus may be isolated or associated with other cardiac anomalies. In some circumstances, it is necessary to prolong life in patients with severe structural heart disease in whom a normal systemic circulation would be incompatible with life:

Non-cardiac associations

Radiographic features

Plain radiograph

Chest radiographic features may vary depending on whether it is isolated or associated with other cardiac anomalies and with the direction of shunt flow (right to left or left to right). Can have cardiomegaly (predominantly left atrial and left ventricular enlargement if not complicated). Obscuration of the aortopulmonary window and features of pulmonary edema may be evident.

Echocardiography

Transesophageal and transthoracic echocardiography has been used to identify these lesions, assess for the presence of complications, and plan surgical intervention. Suspicion is often aroused when a measured shunt fraction (Qp: Qs) is > 1.0, consistent with a left-to-right shunt.

With transthoracic echocardiography, the parasternal short-axis view at the level of the aortic valve with color flow Doppler allows visualization of the flow through a patent ductus arteriosus. It classically appears as a high-velocity jet directed from the far-field toward the main pulmonary artery. Continuous-wave Doppler interrogation reveals continuous flow throughout systole and diastole. Larger lesions, especially with concomitant pulmonary hypertension, may demonstrate lower flow velocities and/or alternating flow direction.

The suprasternal notch view may also depict aliased, continuous flow from the proximal descending aorta toward the right pulmonary artery, visible under the aortic arch in the short-axis.

CT

MDCT can non-invasively provide detailed anatomical information .

Krichenko classification based on CT angiography:

  • type A: conical ductus, prominent aortic ampulla with narrowing at pulmonary artery end
  • type B: window, short and wide ductus with blending of pulmonary artery
  • type C: long tubular ductus with no constrictions
  • type D: multiple constrictions with complex ductus
  • type E: elongated ductus with remote constriction

A ductus may have a tortuous morphology that does not fit in the Krichenko classification. This ductus type is usually observed in premature children and some authors proposed to classify it as type F or fetal type. Compared to types A to E, a type F ductus is larger, longer, tapers minimally from the aortic to pulmonary end, with a tortuous connection to the pulmonary artery giving a hockey-stick appearance .

Treatment and prognosis

  • medical 
    • prostaglandin E1: to keep ductus open
    • indomethacin: to close the ductus
  • endovascular 
    • various closure devices
  • surgical 
    • clipping or ligation to close
Complications

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Persistierender Ductus arteriosus:
hypoplastic
left heart syndrome
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Fallot"sche
Tetralogie
Wikipedia • CC0
persistierendes
Foramen ovale
Wikipedia • CC BY-SA 4.0
Surfactant-Mangelsyndrom
 
Wikipedia • CC BY-SA 4.0
Pulmonalatresie
 
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Eisenmenger-Reaktion
 
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