Nonopacification of Patent Ductus Arteriosus by Aortography in Patients With Large Ventricular Septal Defects

Rao, P. Syamasundar; Thapar, Mohinder K.; Strong, William B.
December 1978
Angiology;Dec1978, Vol. 29 Issue 12, p888
Academic Journal
Patent ductus arteriosus (PDA) in patients with large ventricular septal defect (VSD) predisposes to pulmonary vascular obstructive disease, and selective aortic root angiography has been recommended to diagnose the PDA. The data of 8 patients with VSD and PDA in whom aortography failed to demonstrate the PDA (group A) were compared with data from 5 patients with VSD and PDA in whom PDA was demonstrated on angiography (group B). The PDA was documented in group A patients by passage of a catheter through the PDA at catheterization and/or at subsequent palliative or corrective surgery. All patients in both groups had a VSD murmur and none had a continuous murmur of PDA. The systolic pressures in both ventricles were nearly equal in both groups. suggesting that the VSDs were similar in size. The diamter of the PDA was also similar (P > 0. 1). The site of injections sizes of catheters, amount of Hypaque, pressure with which the contrast was injected, and angiographic projection were similar in both groups. The percentage of O2 saturation in the right ventricle and main pulmonary artery, the pulmonary to systemic flow ratio, the cardiac index, the ratio of systolic, diastolic, and mean pulmonary artery to aortic pressure. the aortic pulse pressure. the pulmonary vascular resistance, and the ratio of pulmonary to systemic vascular resistance were also similar in both groups (P >0.1). Thus the known physiologic determinants of a left-to-right shunt were considered in this study and were found to be similar iii both groups. The reason for non-opacification of the PDA in group A remains unknown. The vascular impedance (instantaneous pressure to flow relationship) in the pulmonary and systemic circulations is perhaps different in the two groups and may he responsible for non-visualization of the FDA. hut it was not measured in this study. In patients with a large VSD, PDA should be suspected and may he best diagnosed by passing a catheter across the ductus.


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