Diagnosis

A definitive diagnosis of PDA is obtained with cardiac catheterization. A presumptive diagnosis of PDA can be obtained by auscultation.

1. Auscultation:
   • presence of a continuous heart murmur
2. Radiology may see:
   • Left ventricular enlargement
   • Left atrial enlargement
   • Aortic bulge (12:00 – 1:00 o’clock on the V/D or D/V view)
   • Main pulmonary artery bulge (1:00 – 2:00 o’clock on the V/D or D/V view)
   • Left auricular bulge (2:00 – 3:00 o’clock on the V/D or D/V view)
   • Pulmonary venous congestion/pulmonary edema
   • Pulmonary overcirculation
3. ECG may see:
   • normal ECG
   • left ventricular enlargement (tall R waves)
   • left atrial enlargement (tall P waves)
   • dysrhythmias both supraventricular and ventricular
   • signs of right ventricular enlargement with reverse PDA
4. Blood Gas
   • normal with classical PDA
   • markedly reduced femoral arterial oxygen content with reverse PDA
5. Echocardiography
   • left ventricular enlargement
   • left atrial enlargement
   • turbulence in main pulmonary artery (presumptive evidence of PDA) by Doppler
   • identification of the ductus arteriosus entering the pulmonary and color Doppler demonstrating left to right flow through the ductus arteriosus
   • signs of right heart enlargement with reverse PDA
6. Cardiac Catheterization
   • Selective angiography of the ductus arteriosus confirming a PDA with left to right or right to left shunt

Comments: The finding of a continuous murmur is strong evidence for PDA and is usually sufficient to warrant surgery