The echocardiogram is the preferred procedure in confirming the diagnosis and characterizing PDA. Doppler echocardiography proved more efficient than clinical examination in grading PDA and becomes essential in the evaluation of clinically significant ductal shunting. Four patterns of PDA shunt can be identified using pulsed Doppler echocardiography: pulmonary hypertension, growing pattern, pulsatile pattern, closing pattern. In this review we confirm that echocardiography can provide a reasonable as well as accurate prediction of the development of later clinically significant PDA by a combination of variables that are easy to measure and compare.