Patent Ductus Arteriosus With Special Reference to Patients with Pulmonary Hypertension

Simple patent ductus arteriosus with a normal or only slightly elevated pulmonary arterial pressure was associated with an estimated life expectancy of 25 years before the era of cardiac surgery and antibiotics. No information is available regarding current life expectancy because almost all patients undergo surgery as soon as the diagnosis is established. The likelihood of premature death from bacterial endocarditis is estimated to be 14%. The operative mortality is about 0.3%. The patient is cured. Concerning the typical hypertensive ductus with a pulmonary arterial systolic pressure of less than 75% of the aortic systolic pressure, there is no precise information regarding life expectancy. Because of the same susceptibility to bacterial endocarditis and a propensity for progression of pulmonary hypertension, it is assumed that the life expectancy is shorter than it is for patients who have a simple ductus. The operative mortality is 0.5% if the pulmonary arterial systolic pressure is less than 45% of the aortic systolic, and 4% if it is between 45 and 75% of the aortic systolic pressure. The patient is cured. In extreme hypertensive ductus , here defined as a pulmonary arterial systolic pressure greater than 75% of the aortic systolic pressure, the average life expectancy is estimated as being in the twenties. The surgical risk is 18%. If the pulmonary exceeds aortic pressure and the shunt is right to left, the surgical risk approaches 100%. Most patients have reversible pulmonary hypertension and appear to be cured by surgery, but a few do not, and if they survive surgery, they remain as pulmonary vascular cripples postoperatively.