Skip to main content
2025 SCMR Conference Main banner
Final Program


Schedule at a Glance
Back
On-Demand Video

P/CHD

P/CHD Case Session

Patent Ductus Arteriosus in Elderly : Diagnostic Approach and Management Implications

Friday, January 31, 2025
8:10 AM – 8:20 AM East Coast USA Time
Location: Palladian Ballroom

    Presenting Author(s)

  • TL

    Tiffany Le, DO, MSc

    Internal Medicine Resident
    Wayne State University/Detroit Medical Center

    • Primary Author(s)

  • TL

    Tiffany Le, DO, MSc

    Internal Medicine Resident
    Wayne State University/Detroit Medical Center

    • Co-Author(s)

  • RT

    Rabih Touma, MD

    Cardiologist
    Wayne State University & Detroit Medical Center & VA Medical Center

  • AA

    Aiden Abidov, MD, PhD

    Section Chief of Cardiology
    Wayne State University & Detroit Medical Center & VA Medical Center

Description of Clinical Presentation:


Patent ductus arteriosus (PDA) is a congenital structure that connects the thoracic aorta (TA) to the pulmonary artery (PA). PDA is typically diagnosed during childhood and closed at an early age. Krupiński et al (2020) described different PDA anatomical variants [1] as displayed in Figure 1 (Panels A-F). Among older adults, the finding of PDA is rare, and the most frequent variant described by Galeczka et al., is Type A (Figure 1) [2]. Here, we present the case of a large PDA in an elderly patient with no significant hemodynamic consequences or clinical symptoms.
Usually, PDA is incidentally found on chest imaging in the absence of symptoms. If the symptoms present, these are often nonspecific [2]. Symptomatic cases can further progress to heart failure and pulmonary hypertension [2]. Echocardiography may overlook PDA.
We will discuss the role of advanced cardiac imaging (Cardiac MRI and CTA) and multimodality approach in assessment of the elderly patients with known or suspected PDA.
A 73- year-old male with a history of hypertension and obstructive sleep apnea was initially referred to cardiology clinic by his primary doctor for evaluation of intermittent dizziness for one month duration. The patient was an athlete and biked 20 miles daily. Physical exam was remarkable for continuous cardiac murmur heard at the base. Of note, his exercise stress test indicated good functional capacity. An echocardiogram revealed LVEF of 55-60%, right ventricular dilation (Figure 2 Panel C), biatrial dilation and mildly dilated proximal ascending aorta. Color flow was evident from the thoracic aorta (AO) to the pulmonary artery (PA) in the suprasternal notch view, with continuous systolic and diastolic flow noted by Doppler in the same position (Figure 2 Panels A,B). Cardiac CTA (CCTA) has defined the anatomy of the PDA as a “tubular variant” (Figure 1 C). Moderate-sized PDA connected the aortic arch with the proximal left PA. (Figure 2 Panels D- F). Subsequently, cardiac MRI (CMR) and MRA of the thoracic AO confirmed these findings (Figure 2 Panels G-I). The patient was offered but declined invasive right heart catheterization at that time. He was optimized medically and routinely follows as outpatient every 6 months.






Diagnostic Techniques and Their Most Important Findings: We carefully reviewed the patient’s chart and collected all the relevant clinical and imaging  data, and performed a comprehensive review of the literature. We searched PubMed the years 2000 through September 2024           

Learning Points from this Case:

Although echocardiography is a primary imaging modality and excellent screening tool in diagnosis of PDA, it has significant limitations (spatial resolution, etc.). Elderly patients have limited Echo windows further restricting diagnostic quality of the images. 



Thus, more aggressive utilization of CMR should be used to aid in the diagnosis of PDA in the elderly. Moreover, CMR provides a physiologic assessment of shunt, and objective quantification of the right heart size and function. Side-by-side comparison of the CCTA, CMR and Echo images provides further insight in improving diagnostic certainty and allows to define an optimal approach to management of these patients. 




Figure 1: Anatomic variants of PDA by Backes et al. [4]

Figure 2: Cardiac MRI , CTA and Echo images of the patient with large PDA . Panel A: Echocardiography: Moderate 3D color flow Doppler echocardiography from the thoracic aorta (AO) to the pulmonary artery (PA). Panel B: Continuous flow Doppler echocardiography from the same position in panel A. Panel C: Contrast enhanced dilated right ventricle (RV) compared to left ventricle (LV). Panel D: 3DVR CCTA image of the thoracic AO and PA revealing large PDA (here and on all subsequent images, PDA is shown white arrow). Panel E: Thick MIP CCTA image of the thoracic AO and PA with adjacent calcification of the aortic arch and ostium of the PDA at its origin (white arrow). Panel F: MPR CCTA image of the PA and PDA. Panel G: 3DVR MRA reconstruction showing the PDA. Panel H: SSFP CMR image of the great vessels revealing the PDA. Panel I: GRE image of the PA showing the PDA related flow artifact.