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Clinical symptoms and diagnostic methods in persistent arterial duct


, : Clinical symptoms and diagnostic methods in persistent arterial duct. Folia Medica Cracoviensia 19(4): 447-460

The clinical course of persistent arterial duct (PAD) in both sexes during development [2 wk-14 yr] was studied. Priority of the importance of clinical, radiologic and ECG symptoms in the diagnosis of this anomaly and the relation to sex and age were assessed from the standpoint of indications for surgical treatment. Clinical observations and examinations were carried out on 97 children (68 girls and 29 boys) [Cracow, Poland]. The course of PAD was similar in boys and girls. The main characteristic features of PAD, in order of frequency in clinical examination, were: machine murmur (87%), tachycardia (64%), purring in the field of the murmur (51%), pallor (49%), raised apical beat (47%), low diastolic arterial blood pressure (42%), sound and murmur over the femoral arteries (38%), radiation of the murmur to the scapula (38%); and in radiograms: convexity of the arch of the pulmonary artery (88%), increased arterial vascularity of the lungs (86%), widening of the cardiac silhouette (76%), enlargement of the left atrium (71%); by ECG, left ventricular hypertrophy (58%). Machine murmur, tachycardia, purring in the area of the murmur, and sound and murmur over the femoral arteries, as basic clinical symptoms of PAD were significantly correlated; raised apical beat was significantly correlated with rapid pulse and purring in the field of murmur; and radiation of the murmur to the scapula with machine murmur and with sound and murmur over the femoral arteries. Ambulatory diagnosis of PAD was possible in 83% of cases. In children under the age of 1 yr, ambulatory diagnosis was established in 37% of cases indicating a significantly atypical course of PAD at this age. The age of children at the time of diagnosis was significantly correlated with onset of symptoms of circulatory failure and the patient's history of past illnesses, but was not dependent on typical clinical, electrophonocardiographic and radiologic symptoms of this anomaly. Younger children, especially under the age of 1 yr, required more frequent angiocardiographic examinations and conservative treatment before and after operation, in contrast to older children. Age at operation, although unrelated to the specific physical symptoms of PAD (except purring in the field of murmur) was not significantly correlated with the clinical data, and may be considered apart from them.

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PMID: 612499


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