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Peddle, VMD,
DACVIM (Cardiology)
Director of the Cardiology Section,
AERA Internal Medicine Department
Understandingpatentductusarteriosus(PDA)
Theductusarteriosusisanormalfetalstructure
connectingthepulmonaryartery(bloodsupply
tothelungs)totheaorta(bloodsupplytothe
body)thatclosesshortlyafterbirthinanormal
individual.Insomenewborns,theductusfailsto
closeandabnormalbloodflowfromthehigh
pressureaorta(leftside)tothelowpressure
pulmonaryartery(rightside)isestablished
throughthispatent ductus arteriosus (PDA).
LefttorightshuntingPDAcanoccurinanydog
orcatbutismorecommonlyseeninthe
followingdogbreeds:
Bichon Frise
Chihuahua
Cocker Spaniel
Collie
English Springer Spaniel
German Shepherd
Keeshond
Labrador Retriever
Maltese
Newfoundland
Poodle
Pomeranian
Shetland Sheepdog
Yorkshire Terrier
ConsequencesofaPDA
ThepresenceofaPDAallowsforlarge
volumesofbloodtoflowfromtheaortato
thepulmonaryarteryandlungs,which
resultsinasignificantvolumeoverloadtothe
leftsideoftheheart.Thiscanleadtocirculatorycongestionandleakageoffluid
intothelungs,asyndromeknownascongestive heart failure (CHF)(formore
informationseeoureducationalbrochureHeart disease and congestive heart
failure).WithmostPDAsthisoccurswithinthefirstfewyearsoflife.Thelarge
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volumeofflowcanalsoleadtoirreversiblepulmonaryvasculardiseaseand
pulmonaryhypertension.Occasionally,verysmallPDAsareidentifiedwhichare
notexpectedtocauseaproblemuntillaterinlife,ifatall.
Diagnosis
DetectionofaPDAmostcommonlyoccursfollowingauscultationofaloud,
machineryqualityheartmurmurattheleftheartbaseonphysicalexaminationina
younganimal.Echocardiography(cardiacultrasound)byaveterinarycardiologist
isrequiredtoconfirmthediagnosisandcharacterizetheamountofflowacrossthe
PDAaswellasassesscardiacstructureandfunction.Chestradiographs(xrays)
helpdetermineifanyactivecongestiveheartfailureispresent.
Treatment
Definitiveclosureviatranscatheterdeviceplacementorsurgicalligationisthe
primarytreatmentforalefttorightPDAinadditiontotreatmentofactive
congestiveheartfailure,ifpresent.Transcatheterdeviceplacementisperformed
byaveterinarycardiologistandisconsideredminimallyinvasive.Duringthis
procedure,alongvascularcatheterisadvancedintotheregionofthePDAviaa
peripheralarteryandusedtoperformanangiogram,orcontrastinjection,intothe
PDAtoassessitssizeandshape.ThenasecondcatheterisusedtodeployaPDA
closuredevice(ductaloccluderorGianturcocoil)underfluoroscopic(realtimex
rayimaging)guidance.Surgicalligationisanotheroptionforclosurebutrequires
openchestsurgery.
Prognosis
Ifleftuntreated,mostPDAsleadtocongestiveheartfailurewithinthefirstfew
yearsoflifeandtheprognosisispoor.InmostcasesthePDAisdiagnosedearlyin
puppyhoodandcardiacfunctioniswellpreserved,suchthatdefinitiveclosureis
curativeandtheprognosisisexcellentforthepatienttoliveacompletelynormal
life.Occasionally,permanentcardiacdysfunctionispresentwhichmayalteran
individualsprognosis.Inrarecaseswherepulmonaryhypertensionhas
developedandareversed,orrighttoleftPDAispresent,closureis
contraindicatedandoverallprognosisispoor.
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