CAN WE DETECT PERSISTENT DUCTUS ARTERIOSUS
IN CHILDREN BY CLINICAL EXAMINATION ONLY ?
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 PDA¡¯s can be detected by ECHO only. It
is important to detect this anomaly if an occlusion or antibiotic
prophylaxis against bacterial endocarditis is advised.