44
Specific Conditions
4.1.5. Patent Ductus Arteriosus
COR LOE
Recommendations
Diagnostic
1 C-LD
1. Adults with a PDA and PAH should be managed by
an ACHD specialist and clinicians with pulmonary
hypertension expertise, to minimize morbidity and mortality.
1 C-EO
2. Patients with an unrepaired PDA should be evaluated for
PAH to guide recommendations for treatment.
1 C-EO
3. Adults with a PDA should undergo assessment of LV function
and left-sided chamber size with echocardiography and/or
CMR imaging, to guide recommendations for treatment.
2a C-LD
4. In adults with a PDA and PAH, balloon test occlusion of
the PDA can be useful to facilitate accurate quantification of
PVR and to identify patients who are candidates for closure.
erapeutic
1 C-LD
5. In adults with a PDA, left heart enlargement attributable to
the PDA, a net left-to-right shunt, and no evidence of PAH
(PVR ≤2 Wood units), closure to eliminate the shunt is
recommended to improve clinical outcomes.
2a C-LD
6. In adults with a PDA, left heart enlargement attributable to
the PDA, a net left-to-right shunt, and PVR >2 but <5 Wood
units, closure to eliminate the shunt is reasonable to improve
clinical outcomes.
2b C-EO
7. In adults with a PDA, left heart enlargement attributable to
the PDA, a net left-to-right shunt, and moderate PAH (PVR
5 to 8 Wood units), closure may be considered if the PVR
drops to <5 Wood units with initiation of PAH therapies.
3: No
Benefit
C-EO
8. In asymptomatic adults with a PDA, no evidence of left
atrial or LV enlargement, and no prior history of endarteritis,
closure has no benefit.
3: Harm C-LD
9. In adults with a PDA and Eisenmenger syndrome or PVR
>10 Wood units, closure to eliminate the shunt should not be
performed to avoid additional morbidity or mortality risk.
