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Medical records and echocardiographic findings reviewed from animals diagnosed with bidirectional or continuous right-to-left PDA. Impact of ductal morphology, spectral Doppler flow profile, PCV, sildenafil treatment at presentation, sildenafil dose, severity of pulmonary hypertension, general anesthesia with or without surgery and the presence of right-sided congestive heart failure (R-CHF) on crude mortality rate were evaluated via Mantel-Cox log rank comparison of Kaplan-Meier survival curves. Univariable and multivariable Cox proportional hazards analysis was performed, and hazard ratio (HR) (95% confidence intervals [CI]) was presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Hindlimb collapse was the most common presenting sign in dogs (n = 16). Clinical signs in cats were variable. Median survival time was 626\u2009days in dogs (range 1-3628\u2009days). Dogs with R-CHF had a shorter median survival time (58\u2009days vs 1839\u2009days, P =\u2009.03). Dogs treated with sildenafil at initial presentation survived longer (1839\u2009days vs 302\u2009days, P =\u2009.03), which was the only independent predictor of survival (HR 0.35, CI 0.15-0.86, P =\u20090.021).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Clinical Importance<\/jats:title>\n                    <jats:p>Dogs and cats with reverse PDA have a variable clinical presentation and prognosis. Survival time was longer in animals prescribed sildenafil at diagnosis. Dogs with R-CHF at presentation have a worse overall outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jvim.16072","type":"journal-article","created":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T03:40:01Z","timestamp":1614310801000},"page":"780-788","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Clinical features and outcome of dogs and cats with bidirectional and continuous right-to-left shunting patent ductus arteriosus"],"prefix":"10.1093","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8093-4174","authenticated-orcid":false,"given":"Victoria","family":"Greet","sequence":"first","affiliation":[{"name":"Southern Counties Veterinary Specialists, Unit 6 Forest Corner Farm ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth F.","family":"Bode","sequence":"additional","affiliation":[{"name":"CVS Referrals, ChesterGates Veterinary 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