Patent ductus arteriosus: treatment and risks
A patent ductus arteriosus is considered a congenital heart defect in which the ductus arteriosus does not grow over after birth. Some early clinical picture may not follow, but then the child develops poorly. At an older age, cardiac arrest may occur due to hemodynamic (blood flow) disorders.
Reasons
Open ductus arteriosus in newborns belongs to the category of white defects - the following are noted:
- so-called left-right bleeding;
- non-mixing of arterial and venous portions of blood;
- pale shade of the skin and visible mucous membranes.
An open ductus arteriosus is formed:
- without any apparent reason (it is called idiopathic);
- in the presence of provoking factors.
Often, an open ductus arteriosus is diagnosed with the following disorders:
- prematurity. An open ductus arteriosus in premature children is detected immediately at birth;
- congenital rubella syndrome;
- chromosomal pathologies.
During intrauterine development of the fetus, the ductus arteriosus connects the pulmonary artery and the aorta. Thanks to this, blood flows from the right ventricle to the lungs of the fetus, which are not yet expanded, it is not overloaded, since an extra portion of blood is discharged through the ductus arteriosus.
After birth, the child takes its first breath, the lungs expand, bradykinin is released from their tissues, under the action of which the wall of the ductus arteriosus begins to contract, then its lumen grows (usually in 15-20 hours).
Fouling of an open ductus arteriosus in children occurs when the tissues of its wall are exposed to oxygen.
The duct may remain open due to the effect on it of prostaglandins that have arrived from the mother's bloodstream.
Symptoms of patent ductus arteriosus and diagnosis
The most characteristic signs of an open ductus arteriosus:
- shortness of breath;
- rapid heartbeat;
- retardation in growth and development.
Physical examination revealed:
- tachycardia – increased pulse;
- when examined - a visible slowdown in the growth and development of the child compared to his peers;
- with percussion (tapping) - an increase in the size of the heart;
- on auscultation (listening) – a long so-called machine noise with an open ductus arteriosus, which can be heard in 2-3 intercostal spaces.
Resort to the following heart research methods:
- X-ray of the chest;
- electrocardiography (ECG);
- phonocardiographic study;
- Ultrasound.
They will help establish changes in the heart that occur due to an open ductus arteriosus. At the same time, the following are determined:
- enlargement of the left ventricle;
- explosion of the pulmonary artery arch;
- overload of the left ventricle.
Symptoms of an open ductus arteriosus correlate with the results of an objective examination.
Open ductus arteriosus: treatment
A premature baby is given drugs that suppress prostaglandins - the ductus arteriosus closes on its own. If there is no effect after repeating the course three times, surgical correction of the defect is indicated.
What are the surgical techniques for the elimination of an open ductus arteriosus? Treatment is carried out by operative methods:
- open means ligation of the duct, application of a special clip to it, crossing and suturing;
- endovascular (through blood vessels) means closing the duct with special occluders.
Read more about methods of treatment of pathology (in particular, about surgery for an open ductus arteriosus) on our website Dobrobut.com.
Prevention and prognosis
The pathology is congenital, so there are no special methods of prevention. The risk of developing this defect can be reduced by providing normal conditions for pregnancy and fetal development.
The prognosis for this disease is different. In the absence of treatment, the disease transforms from a white to a blue type of defect (with bleeding in the "right-to-left" direction). Early diagnosis of open ductus arteriosus is important for a favorable prognosis.
If the child was born prematurely, the presence of an open ductus arteriosus is considered normal.
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