Fortescue Elizabeth B, Lock James E, Galvin Teresa, McElhinney Doff B
Harvard Medical School and Department of Cardiology, Children's Hospital Boston, Boston, MA, USA.
Congenit Heart Dis. 2010 Jul-Aug;5(4):354-65. doi: 10.1111/j.1747-0803.2010.00435.x.
Patent ductus arteriosus (PDA) accounts for approximately 10% of all congenital heart diseases, with an incidence of at least 2-4 per 1000 term births. Closure of the large, hemodynamically significant PDA is established as the standard of care, and can be performed safely and effectively using either surgical or transcatheter methods. The appropriate management of the very small, hemodynamically insignificant PDA is less clear. Routine closure of such defects has been advocated to eliminate or reduce the risk of infective endocarditis (IE). However, the risk of IE in patients with a small PDA appears to be extremely low, and IE is treatable. Although closure of the small PDA is generally safe and technically successful, it is unknown whether this treatment truly improves the risk:benefit balance compared with observation. In this article, we review the published literature on the natural history and treatment outcomes in individuals with a PDA, the epidemiology and outcomes of IE, particularly in association with PDA, and the rationale and evidence for closure of the very small PDA.
动脉导管未闭（PDA）约占所有先天性心脏病的10%，每1000例足月分娩中至少有2 - 4例发病。对于大型、具有血流动力学意义的PDA，关闭导管已成为标准治疗方法，可通过外科手术或经导管方法安全有效地进行。对于非常小的、无血流动力学意义的PDA，合适的管理方法尚不明确。有人主张常规关闭此类缺损以消除或降低感染性心内膜炎（IE）的风险。然而，小型PDA患者发生IE的风险似乎极低，且IE是可治疗的。虽然关闭小型PDA总体上是安全的且技术上是成功的，但与观察相比，这种治疗是否真的能改善风险效益平衡尚不清楚。在本文中，我们回顾了已发表的关于PDA患者自然病史和治疗结果、IE的流行病学及结果（特别是与PDA相关的），以及关闭非常小型PDA的理论依据和证据的文献。
