The Prognosis of Patent Ductus Arteriosus

Surgical intervention is becoming more frequent in patients with a patent ductus arteriosus.At first only marked symptoms were accepted indications for surgery, but these are now becoming much more numerous.This change has largely been due to the gradual decrease of the operative mortality and the dramatic cures effected in cases of bacterial endocarditis.Gilchrist (1946) recommended operation on nearly all uncomplicated cases of patent ductus arteriosus between the ages of 7 and 10 years.The increased risk that the presence of a patent ductus involves is difficult to assess.Surgeons see the more serious cases with symptoms or with infective endocarditis, and the prognosis without operation in such a series is gloomy.Few physicians have published accounts of large numbers.Maud Abbott's (1936) series based on post-mortem records paints too black a picture as patients with infective endocarditis and congestive heart failure tend to end their lives in hospital.Shapiro and Keys (1941, 1943), Shapiro (1944), Wilson and Lubschez (1942), East (1945), and Gilchrist (1945) have all described series of cases but they do not mention how many were referred for symptoms and how many were symptomless.This is important, as if a large number were referred because of symptoms there must be an excess of the more serious cases which naturally gravitate to hospital or the physician's consulting room.In the present series the diagnosis of uncomplicated patent ductus arteriosus was made only in the presence of a typical machinery murmur in the second left intercostal space with no evidence of any other abnormality on physical, cardiographic, and x-ray examination.Forty-six cases have been collected for analysis and divided into two groups.Group A numbers 30 and, save for one woman, aged 23, referred from an ante-natal clinic because of the presence of a machinery murmur, has been collected from a school cardiac clinic.This must include almost every case of patent ductus arteriosus among the.,youngerpeople of Bristol, whether they had symptoms or not.Group B consists of 16 cases from areas outside Bristol referred in a few cases from school clinics but often because of symptoms.It follows that Group A forms a representative sample of the condition while Group B approximates more nearly to the type of case generally reported.Sex Incidence.Of the 60 cases of typical patent ductus arteriosus collected by Shapiro and Keys (1943) 14 were males and 46 females.Steinberg, Grishman, and Sussman (1943) found that of 27 cases 11 were male and 16 female.East (1945) had 4 nales and 9 females, Gilchrist (1945) 13 males and 15 females, and Hunter (1945) found 4 males and 10 females.The ratio of males to females varies considerably but in all series there is a preponderance of females varying from slight to very marked.In the present series 13 are males and 33 females.These figures agree substantially with those of other authors.SYMPTOMS Maud Abbott (1929) states that a fair proportion are dyspneic, and that cyanosis, while' usually absent, may be present on exertion.Steinberg et al. (1943) found 12 of 27 cases 283