From the Guidelines
To order a US for PDA, you should prioritize assessing the patient's clinical indication and suitability for the study, considering factors such as left-to-right shunt, pulmonary overcirculation, and left atrial or ventricular enlargement, as recommended by the 2019 AHA/ACC guideline for the management of adults with congenital heart disease 1. When ordering an ultrasound for a patient with a patent ductus arteriosus (PDA), it is essential to consider the clinical context and the patient's specific condition. The 2019 AHA/ACC guideline recommends PDA closure in adults if left atrial or LV enlargement is present and attributable to PDA with net left-to-right shunt, PA systolic pressure less than 50% systemic, and pulmonary vascular resistance less than one third systemic 1. Key considerations when ordering a US for PDA include:
- Assessing the patient's symptoms and clinical history to determine the urgency of the study
- Evaluating the patient's suitability for transcatheter PDA occlusion, considering factors such as anatomy and patient size 1
- Consulting with specialists, such as adult congenital heart disease (ACHD) and pulmonary hypertension providers, in complex cases 1
- Ensuring proper documentation of medical necessity and relevant patient information to facilitate accurate interpretation of the ultrasound findings. The most recent and highest-quality study, the 2019 AHA/ACC guideline, provides recommendations for the management of adults with congenital heart disease, including PDA closure 1.
From the Research
Ordering a US for PDA
To order a US (ultrasound) for PDA (patent ductus arteriosus), the following steps can be considered:
- The patient's medical history and current symptoms should be evaluated to determine the need for a US examination 2, 3.
- The type of US examination to be performed should be determined, such as transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) 2, 4.
- The US examination should be performed by a qualified healthcare professional, such as a cardiologist or sonographer 2, 3.
- The results of the US examination should be interpreted and used to guide further treatment or management of the patient's condition 2, 3.
Key Considerations
Some key considerations when ordering a US for PDA include:
- The patient's age and weight, as this may affect the type of US examination to be performed and the interpretation of the results 2, 5.
- The presence of any underlying medical conditions, such as congenital heart disease or pulmonary hypertension, which may affect the interpretation of the US results 3, 4.
- The use of any medications, such as indomethacin or ibuprofen, which may affect the patient's condition and the interpretation of the US results 5, 6.
Diagnostic Accuracy
The diagnostic accuracy of US examinations for PDA has been evaluated in several studies:
- TTE has been shown to be a useful tool for guiding transcatheter closure of PDA in extremely low birth weight infants 2.
- TEE has been shown to be highly sensitive and specific for detecting PDA in adolescents and adults 4.
- The use of US examinations to guide treatment and management of PDA has been shown to be effective in improving patient outcomes 2, 3.