Persistent ductus arteriosus in adults. A review of surgical experience with 25 patients

Objective: To review the clinical features, operative details and course of adults with persistent ductus arteriosus. Design: Retrospective study. Information on subjects was obtained by case records review. Setting: The Cardiothoracic Unit, Royal Prince Alfred Hospital, Sydney. Patients: Twenty-five adults aged 16 years and over with persistent ductus arteriosus, from 1974-1990. Intervention: Surgical division or ligation of persistent ductus, via left thoracotomy or median sternotomy. Main outcome measures: Preoperative clinical features; postoperative mortality and morbidity. Results: There was a high incidence of symptoms in this group of adults with persistent ductus arteriosus, many having anatomical (aneurysm, calcification) and/or haemodynamic (heart failure, pulmonary hypertension) complications. There was one death (mortality, 4%) of a young woman with significant preoperative pulmonary hypertension. The remaining 24 patients (96%) left hospital completely well between 4 and 12 days after surgery. Conclusions: Persistent ductus arteriosus, although primarily a paediatric problem, may present in adulthood. Closure by operative means (or in selected cases, by interventional catheter) is warranted in all adult subjects with left to right shunt, other than for patients over 60 years of age with neither heart failure nor cardiomegaly.