Patent ductus arteriosus in the elderly

Patent ductus arteriosus presenting in an elderly patient is unusual. This report describes the oldest patient (72 years) to undergo successful surgical interruption of a patent ductus arteriosus with a unique clinical presentation of typical angina pectoris with normal coronary anatomy. A possible pathophysiologic mechanism for this previously unreported presenting symptom is proposed. The natural history of patent ductus arteriosus and the role of surgery in the elderly patient are discussed.     

Patent ductus arteriosus and high altitude

Patent ductus arteriosus is more likely to be found in patients born at high altitudes. The effect becomes manifest at altitudes of over 3,000 meters and is most evident at altitudes of over 4,000 meters.

It is presumed that mechanical factors affecting the pulmonary circulation as well as the lower oxygen tension may influence persistent patency of the ductus arteriosus.

High altitude does not appear to be an etiologic factor in coarctation of the aorta.     

Patent ductus arteriosus in premature infants

An analysis of the course and complications in the ligation of patent ductus arteriosus (PDA) in 30 very low birth-weight preterm neonates was carried out. The mean gestational stage at birth was 26.97 weeks, and median weight was 811 gm. Attempted closures of the ductus with indomethacin in 19 infants failed, although there was temporary closure in nine. Congestive heart failure was present in 29 and respiratory distress syndrome in 22 patients. Endotracheal intubation with ventilation assistance was necessary in the entire series. The mean age at operation was 13.5 days, and ductal ligation was performed in the intensive care unit under local anesthesia, supplemented with pancuronium and pethidine. There were no intraoperative deaths, but five infants died during their hospitalization from unremittent respiratory distress syndrome. There were seven additional late deaths. Eighteen survivors were followed for a mean of 26.5 months. Early ligation of PDA in very low birth-weight prematures improved the cardiorespiratory status, and long-term follow-up revealed good clinical progress in two-thirds of the surviving group.     

Patent ductus arteriosus in the premature neonate

This article has reviewed current thought on the pathophysiology, medical management, and nursing implications of PDA in the premature newborn. The ductus arteriosus is a normal vascular channel that provides a route for blood flow to the descending aorta in the fetus; and it is an abnormal channel in the newborn that allows additional pulmonary blood flow to be shunted from the higher pressured aorta. Left heart volume overload and additional insults in connection with concurrent RDS and BPD were discussed. Current management for closure advocates indomethacin administration, and ligation, should indomethacin fail or be contraindicated. Continued patency with prostaglandin administration is the objective in cyanotic neonates with congenital heart disease and diminished pulmonary blood flow and in acyanotic neonates with aortic arch abnormalities that lead to decreased descending aortic flow. Nursing responsibilities encompass the well-being of the newborn as well as the family. The neonate must be assessed frequently for signs of cardiopulmonary deterioration. The neonate's responses to drug administration must be monitored for their effect on the ductus and the minimization of side effects. Care of the parents regarding support and information was discussed.     

Patent ductus arteriosus in old age.

An unusual case of patient ductus arteriosus (PDA) in a 78-year-old man is presented. The patient was known to have PDA since the age of 30, but it had remained well compensated until shortly before death. He had undergone some difficult operations successfully, and had no specific pulmonary complaints. Death at age 78 was caused by arteriosclerotic heart disease following myocardial infarction. Autopsy revealed a smooth patent ductus arteriosus with no perforation. The survival of a PDA patient to such advanced age is a comparatively rare occurrence.     

Patent ductus arteriosus presenting in old age

This report describes an unusual case of patent ductus arteriosus, presenting in old age. The patient is the oldest living female with patent ductus reported thus far in the medical literature [1,2]. She initially presented with chest pressure and dyspnea, and subsequently developed subacute bacterial endocarditis and typical angina pectoris with ECG changes, but with normal coronary anatomy.     

Patent ductus arteriosus with hypoplastic lung.

A median sternotomy approach was used for closure of patent ductus arteriosus associated with a hypoplastic right lung. The anterior approach to the left ductus is indicated if left thoracotomy is contraindicated.