Vucajnk L

General Hospital, Paediatric Department, Celje, Slovenia


Objective: It is well established that the persistence of ductus arteriosus (PDA) can be easily detected by clinical examination because of the typical machinery systolo-dyastolic heart murmur over the left upper sternal border. Small PDA has only mild systolic murmur grade 2/6. Is it possible to exclude PDA by a clinical examination of a child only?

Methods: In a prospective 38 months long study (from 1. 1. 1998 to 28. 2. 2001) 2882 children with heart murmur were examined at the Paediatric Department of General Hospital in Celje, Slovenia. Children were aged from 3 months to 17 years. There were examined 1436 boys and 1446 girls.  Clinical assessment, ECG and ECHO were performed to each patient.

Results: By using ECHO examination isolated PDA was detected in 21 (0,7%) children aged from 6 months to 15 years. There were 9 boys and 12 girls. Only one child had typical systolo-dyastolic heart murmur, seven had predominantly systolic with mild protodyastolic murmur, thirteen had only systolic murmur grade 2/6 over the left upper sternal border which can be clinically defined as an innocent heart murmur. None of those children had pulmonary arterial hypertension.  

Conclusion: It is not possible to exclude PDA with clinical examination of a child only. Small PDA has atypical systolic heart murmur over the left upper sternal border that can be easily mistaken for an innocent heart murmur. Such small PDAs can be detected by ECHO only. It is important to detect this anomaly if an occlusion or antibiotic prophylaxis against bacterial endocarditis is advised.