Sound of the heart. Patent ductus in an elderly man

Persistence of ductus arteriosus with left to right shunt in the older patient

Eight hundred and four patients with persistence of the ductus arteriosus were seen in Edinburgh between 1940 and 1979. Thirty-seven of them reached the age of 50 years, and in 32 the shunt was exclusively from left to right. Fifteen of the 32 were subsequently treated surgically. None of the 32 was lost to follow-up. Duration of clinical observation averaged 17 years and extended to over 30 years in eight patients. Their features have been correlated with those from reports of 48 comparable patients in an attempt to clarify the management of the persistent ductus in the older patient. Impairment of left ventricular function is shown as the major risk, even when the ductus is small. Bacterial endarteritis is infrequent. Surgical treatment carries greater risk than in childhood and early adult life but usually reduces heart size and restores exercise tolerance. Left ventricular dysfunction, however, occasionally vitiates the benefits; symptoms are then incompletely relieved and death from heart failure may occur months or years after operation. Experience in older patients thus emphasises the value of elective operation in childhood, however well the child, however trivial the shunt. It is concluded that in older patients, the presence or the development of symptoms or cardiac enlargement are almost always indications for surgical treatment. As age increases, especially by the eighth decade, medical treatment may be preferable. Continued follow-up of symptomless patients without cardiomegaly is important because increase in heart size usually precedes further deterioration which can then be prevented by timely surgical treatment.

Surgical technique in the management of patent ductus arteriosus in the elderly patient

The successful surgical treatment of a patent ductus arteriosus in a 68-year-old man is presented. A review of current methods for repair is discussed, with emphasis on the simple and safe technique described here.

Patent ductus arteriosus in adult patients with aortic valvular disease: the importance of routine screening for a left-to-right shunt at cardiac catheterization

Two patients, catheterized primarily for the preoperative assessment of clinically apparent aortic stenosis and insufficiency, were found to have a patent ductus arteriosus as well at cardiac catheterization. The association of aortic valve disease and patent ductus arteriosus is reviewed, and the importance of making the diagnosis prior to aortic valve replacement is stressed, emphasizing the routine use of the hydrogenplatinum electrode system.