Unusual Manifestations of Patent Ductus Arteriosus in Infancy

Abstract

Seven cases (five girls and two boys) with an isolated patent ductus arteriosus demonstrate a myriad of unusual clinical features early in life. The auscultatory -phonocardiographic findings may be consistent with a patent ductus arteriosus, but the electrocardiogram may suggest a co-existing malformation. One electrocardiogram showed isolated right ventricular hypertrophy; the other mimicked the pattern usually associated with endocardial cushion defects — both highly unusual in cases with an isolated patent ductus arteriosus. Other common congenital malformations may be suggested by the auscultatory-phonocardiographic findings, such as ventricular septal defect, mitral insufficiency, and coarctation of the aorta. Unemphasized previously is the finding that with the onset of cardiac failure the classic murmur of patent ductus arteriosus may become apparent. The auscultatory-phonocardiographic findings may suggest no particular defect when an infant presents without a significant murmur or when an insignificant systolic murmur is accompanied by a loud pan-diastolic murmur. These unusual observations make it mandatory to evaluate any symptomatic infant with a left-to-right shunt for a patent ductus arteriosus even though the clinical findings may not suggest this lesion. This diagnosis is probably made with the highest degree of certainty by retrograde aortography, utilizing a catheter positioned above the aortic valve. Such an examination also delineates lesions of the aortic sinuses, coronary arteries and the aortic arch system.