Overview Snapshot An infant presents with a pink torso and upper extremity, with blue lower extremities. A bounding pulses and a "to-and-fro" machine-like murmur is noted on auscultation. Introduction Failure of the patent ductus arteriosus to close in the first few days of life causes blood to flow from aorta to pulmonary artery starves the periphery of O2 usually results in left to right shunt VSD, PDA, ASD Risk factors include prematurity high altitude rubella infection in 1st trimester genetic conditions Presentation Symptoms asymptomatic mild dyspnea lower extremity clubbing congestive heart failure Physical exam bounding peripheral pulses with hyperactive precordium "machinery murmur" continuous at the 2nd intercostal space (LUSB) widened pulse pressure loud S2 Evaluation Echocardiogram is diagnostic gold standard demonstrates shunt left-sided cardiac enlargement EKG may show LVH Differential Aortopulmonary window, truncus arteriosus, mitral regurgitation, VSD, aortic stenosis, and Eisenmenger's syndrome Treatment Indomethacin indications first line of treatment administered to close the PDA contraindications Transposition of the Great Vessels PDA is necessary for survival in patients with transposition use prostaglandin E to keep PDA open in TGA Surgical closure indications required if indomethacin fails in a child >6-8 months Prognosis, Prevention, and Complications Prognosis good if identified early Prevention maternal glycemic control Complications pulmonary hypertension of the newborn flow may be right to left endocarditis pulmonary vascular disease