Patent ductus arteriosus in the adult with partial reversal of flow.

The clinical and physiological characteristics of the uncomplicated patent ductus arteriosus in the adult have been well-defined and understood for many years. A typical continuous murmur usually develops early in life; the electrocardiogram is usually normal or shows a left axis deviation; and heart fluoroscopy ordinarily shows only mild to moderate left ventricular enlargement, vigorous aortic pulsation, and increased pulmonary blood flow. In addition, cyanosis does not occur unless severe congestive cardiac failure develops in the terminal stages of the disease.1 In 1925, following a review of 16 atypical cases of patent ductus arteriosus in which right ventricular hypertrophy was present, it was pointed out that reversal of flow through the ductus arteriosus and the consequent development of lower extremity cyanosis and clubbing could and probably did occur in at least six of the patients studied.2 Recently the syndrome of patent ductus arteriosus with pulmonary hypertension and reversal of flow through the ductus arteriosus has been well-described and documented in scattered reports.3 #{176}The following cases are believed representative of that group. Case Reports