This protocol addresses adult patients with patent ductus arteriosus (PDA) who present with evidence of left ventricular volume overload — specifically LV enlargement with increased stroke volume — in the absence of pulmonary arterial hypertension.
The patient has PDA with demonstrated LV enlargement and increased stroke volume consistent with volume overload. Pulmonary arterial pressure is not elevated: either there are no non-invasive signs of PAP elevation, or invasive assessment has confirmed pulmonary vascular resistance below 3 Wood units.
In this setting, PDA closure is recommended regardless of whether the patient is symptomatic. A catheter-based interventional approach is generally preferred when anatomy is suitable. The choice between approaches depends on anatomical and technical factors — the complete structured regimen is available via the link below.
DOI: 10.1093/eurheartj/ehaa554
In patients with evidence of LV volume overload and no PAH (no non-invasive signs of PAP elevation or invasive confirmation of PVR <3 WU in case of such signs), PDA closure is recommended regardless of symptoms.
LV enlargement with increased stroke volume.
Device closure is recommended as the method of choice when technically suitable.
Device closure is the method of choice, even if cardiac operations are indicated due to other concomitant cardiac lesions, and can be successfully performed in the vast majority of adults with a very low complication rate.
Surgery is reserved for the rare patient with a duct too large for device closure or with unsuitable anatomy such as aneurysm formation.
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