Prevalence of Late-Presentation PDA in Adults
PDA is found in approximately 0.3% to 0.8% of term infants, but delayed clinical presentation into adulthood is very rare, as most cases are diagnosed and treated in infancy or childhood. 1
Epidemiological Context
- PDA represents 5-10% of all congenital heart defects, making it a commonly diagnosed lesion in the pediatric population 2
- The condition is twice as common in females compared to males 1
- Most PDAs are identified and managed during infancy, with symptoms and signs typically occurring early in life, leading to treatment shortly after diagnosis 3
Why Late Presentation is Uncommon
The rarity of adult presentation stems from several factors:
- Spontaneous closure occurs within 24-48 hours after birth in the majority of cases, eliminating the defect naturally 2
- Modern screening and diagnostic capabilities identify most hemodynamically significant PDAs during routine pediatric care 4
- Symptomatic PDAs in childhood prompt early intervention, preventing progression to adulthood with an undiagnosed defect 3
Clinical Spectrum in Adults Who Present Late
When PDA does present in adulthood, the clinical manifestations vary dramatically:
- The clinical spectrum ranges from asymptomatic to severe Eisenmenger physiology, depending on PDA size and pulmonary vascular resistance 1
- Adult presentations typically consist of either aortic or pulmonary valve endocarditis as the initial manifestation 5
- Some patients remain undiagnosed until adulthood despite having symptoms, representing a subset who survived without detection 3, 6
Important Clinical Pitfall
- A subset of patients survives to adulthood completely undiagnosed, presenting with various clinical manifestations that depend on PDA size, magnitude of shunting, and pulmonary vascular status 6
- Prior echocardiography may have missed the diagnosis, as documented in cases where patients had known cardiac history but PDA was not identified until acute decompensation occurred 5
The key takeaway: while PDA itself is relatively common among congenital heart defects, late presentation in adults represents a rare clinical scenario because most cases either close spontaneously, are diagnosed in childhood, or are treated early in life.