MeSH
| Ductus Arteriosus, Patent |
Echocardiography |
Heart defects, congenital |
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There are only very few publications which document reactivity of patent
ductus arteriosus. Dennis et al, reported the intermittent disappearance
of a patent ductus arteriosus murmur in a ten year old girl.1
They noticed that at the time when they published their report, already
12 other patients were known to have intermittent disappearance of their
murmur. Seven years before, intermittent functional closure of patent ductus
arteriosus in a ten-month-old infant has been documented hemodynamically.2
A report from Germany had shown that the duct can increase in size during
the manipulations at transcatheter procedure.3 Another case
report from India, documented the severe spasm of a large patent duct during
an interventional procedure.4
In contrast to these reports, we documented the reactivity of a patent
arterial duct in a one year old infant, 6.5 kg weight during a routine
echocardiographic color Doppler study. Echocardiographic images were obtained
during conscious sedation. The boy remained calm and asleep throughout
the study.
In the previous cases, it was suggested that duct widened or went into
spasm either in response to angiography or to the manipulations of the
catheter.3,4 In our case and within a time frame of only 10
minutes, the duct changed its size gradually from a barely seen left to
right shunt (Figures 1,2 and 3) into a moderate sized (>3.3 mm) duct.(figures
4 and 5). To our knowledge, this is the first time that the reactivity
of a patent arterial duct has been documented echocardiographically.
Figure 1: Ductul view at 11:30, showing a small duct with small
ampulla, no shunt.
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Figure 2: Ductul view at 11:33, showing a small duct with small
left to right shunt across it.
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Figure 3: Ductul view at 11:38, showing a moderate patent duct
with moderate flow across it.
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Figure 4: Ductul view at 11:39, showing a larger patent duct
with significant flow across it.
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Figure 5: Still frame in the ductul view, showing on the left
side the left pulmonary artery and the duct, on the right hand side the
color across the 3.3 mm patent arterial duct at its narrowest diameter.
Ductal reactivity in late infancy remains an unusual occurrence. Despite
the reports of intermittently disappearing murmurs, until recently, it
has been doubted that ductal diameter change occurs in absence of any direct
or indirect manipulation of the arterial duct. Our report shows that reactivity
of the duct can happen without any mechanical reason. This fact should
make us more alert during transcatheter closure. Especially in young children
less than 2 years of age, multiple angiographic injections should be done
during transcatheter closure and especially before releasing the device,
to ensure that the duct did not change its size or its shape.
References
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Cokkinos DV, Leachman RD, Lufschanowski R. Intermittent disappearance of
a patent ductus arteriosus murmur: Case report and review of the literature.
Tex Heart Inst J. 1982;9:57–60.
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DuBrow IW, Fisher E, Hastreiter A. Intermittent functional closure of patent
ductus arteriosus in a ten-month-old infant; hemodynamic documentation.
Chest 1975;68:110–113
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Dittrich S, Berger F, Nürnberg JH, Borm B, Lange RE. Reactivity of
patent ductus arteriosus : management during transcatheter occlusion. Monatsschrift
fuer Kinderheilkunde 1997;145:798-801
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Kannan BRJ, Sadhananthan AK, Kumar RK. Severe spasm of a large patent ductus
arteriosus. Ind Heart J. 2005; 57:274-274
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Contact information
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Contact information
Mohammed Omar Galal
Prince Salman Heart Center, King Fahad Medical City,
11525 Riyadh,
PO Box 59046
Saudi Arabia
Fax: 00966-1-2889999 ext 1108
Email: ogalal@yahoo.com
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