Patent ductus arteriosus in patients more than 50 years old.

At the Mayo Clinic, from 1945 through 1983, a definitive diagnosis of patent ductus arteriosus was first made in 38 patients when they were more than 50 years old. Of the 29 patients who had cardiac catheterization, 14 had a small left-to-right shunt, 7 had a moderate shunt, and 8 had a large shunt. Five patients, including 2 with right-to-left shunts through the ductus, had pulmonary systolic pressures greater than 75 mm Hg. Thirty procedures were done in 29 patients: ductal ligation in 7, division and suture in 13, transaortic patch closure in 3, and closure via median sternotomy with extracorporeal circulation in 7. There was one intraoperative death (operative mortality, 3.3%). Although technically more challenging, surgical repair is associated with low mortality and excellent follow-up survival. The patients who benefit most from surgical correction are those with Qp/Qs greater than 1.5 and pulmonary artery systolic pressure less than 75 mm Hg.