Patent Ductus Arteriosus Aneurysm (DAA)

Question 1

What is Patent Ductus Arteriosus Aneurysm (DAA)?

Answer 1

DAA is a saccular or fusiform dilatation of the ductus arteriosus.

DAA typically presents as a large, thin walled dilatation often ending as a small tortuous PDA on the pulmonary side.

Question 2

What is the typical internal diameter of a ductal aneurysm compared to the transverse arch or descending aorta?

Answer 2

The internal diameter is usually equal to or larger than the transverse arch or descending aorta.

Question 3

What are the two types of ductal aneurysms?

Answer 3

Ductal aneurysms can be either congenital or acquired.

Question 4

What is the most common age for a ductal aneurysm?

Answer 4

Less than 2 months.

Question 5

What significant complications can arise from DAA?

Answer 5

Complications include:
* Compression of surrounding structures
* Thromboembolism
* Spontaneous rupture

Question 6

How can DAA be identified in utero?

Answer 6

DAA has been demonstrated in utero by fetal echocardiography.

Question 7

What connection exists between ductal aneurysms and connective tissue disorders?

Answer 7

There may be a strong correlation between ductal aneurysms and connective tissue disorders like Marfan and Ehlers-Danlos syndromes.

Question 8

What are common symptoms of DAA in newborns?

Answer 8

Symptoms can include:
* Murmur
* Cyanosis
* Stridor
* Respiratory distress
* Weak or feeble cry

Question 9

What can be seen on a chest x-ray in cases of DAA?

Answer 9

A prominent ductal ‘bump’ can be seen.

Question 10

What is the natural course of ductal aneurysms in asymptomatic patients?

Answer 10

Ductal aneurysms can resolve spontaneously, with symptoms often being transient.

Question 11

What are the stages described in case studies for the natural resolution of DAA?

Answer 11

Stages include:
* Compression
* Septation/loculation
* Thrombus formation
* Eventual resolution

Question 12

When might surgical repair be necessary for DAA?

Answer 12

Surgical repair may be necessary if there is significant compression or concern for possible rupture.

Question 13

What is the modality of choice for ruling out a DAA?

Answer 13

Echocardiography

X-ray, CT, and MRI can provide additional information for diagnosis.

Question 14

What are the best echocardiographic views for diagnosing a DAA?

Answer 14

High left parasternal and suprasternal views

Question 15

What unusual direction of PDA flow may indicate a ductal aneurysm?

Answer 15

Flow into the main pulmonary artery

Question 16

In a high left parasternal, short axis view, where is a DAA identified?

Answer 16

Leftward and superior to the LPA, entering into the MPA

Question 17

What three large vessels are seen in the high left parasternal view?

Answer 17

• Ascending aorta
• MPA
• Ductal aneurysm

This configuration is referred to as the ‘triple star sign’.

Question 18

What is the ‘Rabbit ear sign’ in suprasternal notch short axis imaging?

Answer 18

Right ear: transverse aortic arch and descending aorta; Left ear: ductal aneurysm

Question 19

What structures may mimic a DAA?

Answer 19

• Mirror image of the pulmonary artery
• Normal prominent ductal bump
• Left SVC
• Dilated atrial appendage
• Vertical ductus arteriosus

Question 20

If a dilated and tortuous vascular structure is visualized protruding left of the aortic arch, what must be excluded?

Answer 20

DAA