Patent ductus arteriosus in the absence of a continuous murmur

The diagnosis of patent ductus arteriosus is difficult when the classic continuous murmur is not present. In infancy, in the presence of cardiac decompensation and when the ductus approximates the aorta in size, the continuous murmur is frequently absent. A correct diagnosis may be important, however, for a large patent ductus arteriosus can cause serious difficulty. Early surgical treatment may be lifesaving. In this series a large patent ductus was associated with pulmonary hypertension, great cardiac enlargement and absence of the continuous murmur. The presence of pulmonary hypertension is further reason for early surgical treatment.