PATENT DUCTUS ARTERIOSUS AND ITS SURGICAL TREATMENT

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Abstract
A presentation of the clinical and diagnostic problems, which stresses the little-known diastolic blood pressure fall after exercise characteristic of this congenital defect. Whereas normally systolic and diastolic pressures rise after simple exercise, an immediate transitory fall in diastolic pressure, often as much as 50-60 mm. occurs in this condition (with the usual systolic rise). Quick physiologic adjustments to exercise (pulmonary and peripheral vascular dilatation and increased blood flow) seem responsible for an increased shunt of blood from the aorta through the patency into the pulmonary circuit, and all the clinical phenomena of a high pulse pressure occur. The duration of effect may be only 1-2 mins., but this mechanical alteration of a physiologic response, due to a mechanical defect, is regarded as of diagnostic importance. Clearly the reaction is important if obtained, but it is not stated whether it was obtained in all cases. However, in his 13 operated cases, the pre-operative diastolic pressures were all low, and 1-7 mos. afterwards, 12 of these had marked significant rises in diastolic pressure to the normal range, and in 8 the systolic pressure rose too but not beyond the normal range.