Patent Ductus Arteriosus in an Elderly Man

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     An apparently healthy 62-year-old man was admitted because of a one-month history of progressive dyspnea on exertion. He reported leg edema, but no orthopnea or paroxysmal nocturnal dyspnea. On physical examination, his oxygen saturation was 94 percent while he was breathing room air, his lungs were clear, and there was no clubbing of the toes, but a harsh, grade 2/6 holosystolic murmur was heard in the aortic area with radiation to the back. The B-type natriuretic peptide level was elevated at 862 pg per milliliter (normal, <100). A subsequent echocardiogram showed global hypokinesis, a left ventricular ejection fraction of 30 percent, a moderate, almost continuous but predominantly diastolic color flow in the main pulmonary artery distal to the pulmonic valve, a right ventricle that was of normal size and function, and an estimated pulmonary-artery systolic pressure of 57 mm Hg. High-resolution computed tomographic angiography of the heart revealed a patent ductus arteriosus (PDA), with flow of contrast from the aorta (A) to the pulmonary artery (PA) (Panel A). A three-dimensional sagittal image reconstruction demonstrated the course of the PDA between the aorta and the pulmonary artery (Panel B). Cardiac catheterization demonstrated no clinically significant epicardial artery disease. Thus, the PDA was considered the underlying cause of the patient's congestive heart failure. The patient is currently being evaluated for PDA closure. Undetected PDAs can present as congestive heart failure in adults.

    Edsel Maurice T. Salvana, M.D.

    Medical College of Wisconsin

    Milwaukee, WI 53226

    http://www.100md.com/html/DirDu/2007/01/01/32/78/60.htm