Patent Ductus Arteriosus in a Woman Aged 72 Years

Patent ductus arteriosus is as a rule incompatible with great longevity.In Abbott's (1936) series of 1000 cases of congenital cardiac disease, the mean age of the 92 with uncomplicated patent ductus was 24 years, the oldest being 66 years.Josefson (1897) and White (1928) found patent ductus at necropsy in patients of 66 years and 65 years and 9 months respectively; in White's patient the diagnosis was made two years before death.Walker and Ellis (1941) described a man with this condition, who was still, at the age of 73 years, in good health; he died at the age of 78 but there was no necropsy (White, personal communication).By means of cardiac catheterization in a woman, aged 71, we have recently been able to verify the diagnosis of patent ductus arteriosus made clinically 41 years ago.This patient is still living and is able to attend to her household duties.The patient, M.S., born in 1879, was treated in Bergen City Hospital in 1909 (the chief physician at that time being Dr. Klaus Hanssen); the diagnosis was thought to be patent !ductus arteriosus.She complained of palpitation of the heart '_ _ and dyspncea on exertion.On examination a continuous buzzing sound was heard over the second left interspace, and the second pulmonary sound was accentuated.A pulse tracing showed a rapid pulse and extrasystoles on exertion (Fig. 1).Since then she has been in relatively good health, apart from occasional extrasystoles and dyspncea on exertion.For several years her ankles have been swollen, especially in connection with attacks of coughing and expectoration.Since the fall of 1948 she has been treated by her physician " I , for congestive heart failure.She was admitted to this hospital in January, 1949.She was then found to be suffering from auricular fibrillation; her blood pressure was 135/70 in the right arm and 120/80 in the left; her pulse was of Corrigan type.In the second and third left interspace was heard a continuous systolic-diastolic " machinery " murmur (Fig. 1).S f "h"' The liver was felt just below the costal arch; there was cedema of the ankles.The venous pressure, 40 mm., was FIG.l.-Sphygmogram taken in 1909 normal, and the circulation time somewhat prolonged-24 and phonocardiogram of the seconds for the first and 65 seconds for the last taste of patient taken recently.276