To the Editor:
I read with interest the article by Vaisbourd et al.  published in the recent issue of Journal of Perinatology. They described decrease in coronary artery flow and higher troponin values suggesting it as a “steal effect” in association with patent ductus arteriosus (PDA).
Ductal steal is a phenomenon where blood from the aorta is shunted to the pulmonary artery through the PDA. The ductus is a remnant of the distal sixth aortic arch and connects the proximal descending aorta to the main pulmonary artery. The pre-ductal main arteries that arise from aorta include the coronary arteries, the brachiocephalic artery (divides into right subclavian and right common carotid arteries) and left common carotid artery. The ductal shunt and “steal” theoretically should not affect the blood flow into these major arteries as they arise proximal to the origin of ductus. As coronary blood flow happens during diastole, a plausible reason for the finding of decreased coronary flow with PDA would be the decrease in the distal blood flow due to run-off through the PDA during diastole, in addition to a lower diastolic blood pressure from the run-off.
Vaisbourd Y, Sharif D, Riskin A, Yaniv L, Dinur G, Amen K, et al. The effect of patent ductus arteriosus on coronary artery blood flow in premature infants: a prospective observational pilot study. J Perinatol. 2020;40:1366–74. https://doi.org/10.1038/s41372-020-0622-4.
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Manzar, S. Ductal steal: does it affect pre-ductal arteries. J Perinatol 41, 179 (2021). https://doi.org/10.1038/s41372-020-00851-4