PERSISTENT DUCTUS-ARTERIOSUS - SHOULD IT BE CLOSED EVEN IN ASYMPTOMATIC ADULTS WITH SMALL DUCTUS AND INSIGNIFICANT LEFT-TO-RIGHT SHUNT

We hypothetized that conservative treatment might be justified in asym ptomatic adults with a small persistent ductus arteriosus. The data of 100 patients (age, 18-72 years) who later underwent non-operative clo sure were retrospectively analyzed. Left- and right-heart catheterizat ion as well as angiographic measurement of PDA-size had been performed in all patients. Thirty-five patients were asymptomatic and 65 patien ts had cardiac symptoms. Six patients had a history of endocarditis. T here were no significant differences with respect to Qp/Qs ratio (1.69 +/- 0.45 vs. 1.57 +/- 0.32) and ductus-diameter (4.7 +/- 1.4 mm vs. 4 .8 +/- 1.3 mm) between symptomatic and asymptomatic patients. In the s ix patients with endocarditis the diameter was 4.5-7.0 mm. Symptomatic patients had higher mean pulmonary artery pressures (22.1 +/- 9.7 mm Hg vs. 18.5 +/- 5.1 mm Hg; p < 0.05) and were older (48.4 +/- 14.3 yea rs vs. 30.9 +/- 11.2 years; p < 0.001) than asymptomatic patients. Nei ther from the size of the ductus nor from the Qp/Qs ratio could the de velopment of cardiac symptoms or the risk of endocarditis be predicted individually. From these data it might be concluded that closure shou ld be performed even in asymptomatic adults with small ductus and insi gnificant left-to-right shunt.