One of the congenital white heart defects is called the open arterial duct. To white vices are those in which the venous blood does not enter the large circle of blood circulation, to the blue ones - with a right-to-left discharge. If you do not treat the PDA, then the disease easily passes into the blue stage, and this is much worse.
Features of the
Disease The open arterial duct is a small vessel that connects the pulmonary artery to the descending aorta. Otherwise it is also called Botallov duct. It is a natural shunt and is designed to supply the fetus with blood that is enriched in oxygen. And simultaneously acts as protection of the right ventricle from overloads with discharge of superfluous blood. After the birth of the child, together with his first breath, the need for the OAA disappears, and it closes for several hours. There are cases when the closure of the Botallus duct lasts up to fifteen days, but this is a rarity.
With a large duct, there are all signs of cardiac overload, shortness of breath and the number of pulmonary diseases in the form of frequent colds, pneumonia and acute respiratory infections. In newborns with a duct size of about 9 millimeters or more( this is the diameter of the aorta), the heart occupies almost the entire thorax and displaces the lungs, hampering their development. In this case, the life of the child can be saved only by surgical intervention.
In preterm infants, there are two scenarios of the development of the situation with an open arterial flow.
- If the diameter of the pathology is small and the weight of the child is more than two kilograms, the case is not urgent and requires observation. The body copes with the load on the heart and maybe the duct closes itself.
- But if the newborn is in kuveze and its weight is less than one kilogram - you can not delay. In such cases there is a high probability of hemodynamic disorders. The risk is also associated with the fact that such children are usually connected to the artificial respiration apparatus and their transportation to cardiosurgeons is impossible. To carry out the operation to eliminate the blemish, doctors perform an operation on site.
In adults, such an ailment, the open arterial duct, as a rule, is absent. Surgical intervention to eliminate the open ductus arteriosus is carried out in childhood.
Schematic diagram of open arterial duct
Forms and classification of
Open Botallus duct is classified into four degrees of pressure in the pulmonary artery:
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- does not exceed forty percent of the arterial;
- from forty to seventy five percent - moderate pulmonary hypertension;
- more than seventy-five percent with preservation of left-right blood flow - pronounced pulmonary hypertension;
- , the pressure in the pulmonary artery is greater than or equal to the arterial artery. The discharge of blood changes to the right-left and a severe degree of pulmonary hypertension appears.
During the course of the disease:
- primary adaptation( first stage).Characterized by the development of the disease with the manifestation of all symptoms. Very often accompanied by exacerbations, which in twenty percent of cases lead to death. It is observed in children under three years old;
- relative compensation( second stage).It determines the dynamics and long-term existence of small-scale hypervolemia, systolic right ventricular overload and relative stenosis of the left atrioventricular orifice. It is observed in patients aged from three to twenty years;
- sclerotic change in pulmonary vessels( third stage).Reconstruction of pulmonary capillaries and arterioles with dynamic development of sclerotic deformations in them. Replacement of symptoms of an open arterial flow on all signs of pulmonary hypertension.
According to the data from the old reference books, when the open arterial flow had not yet operated, the person with this disease lived up to a maximum of thirty-five years.
Very detailed about the anatomy and features of treatment of the open arterial duct will tell the following video:
Causes of the occurrence of
The causes of this disease can be divided into two types:
- genetic. Different heart defects are present in close relatives of the patient. They are the result of a change in the gene or chromosomes. At its core are mutations;
- environmental. Due to the impact of adverse environmental influences on the parents or the fetus. Very often, a harmful effect on a pregnant woman leads to the appearance of premature babies - this is the main group that can develop an open arterial duct.
Symptoms of
The development of symptoms is characteristic only with a large amount of open Botallus duct:
- lag in physical development;
- pallor of the skin;
- dyspnoea with physical exertion;
- high fatigue and weakness;
- persistent swelling of the legs;
- intolerance to physical activity;
- feeling of irregular or rapid heartbeat;
- when creeping and straining there is a cyanosis of the skin of the legs;
- is a propensity for frequent pulmonary diseases.
On how to diagnose the open ductus arteriosus, read below.
Diagnosis of the open arterial duct
The doctors diagnose the OAA on the basis of the following factors:
- a complete analysis of the complaints of the patient or his parents;
- analysis of the occurrence of symptoms and their comparison;
- general examination, blood, feces and urine tests;
- results of ECG( electrocardiography);
- chest X-ray;
- retrograde aortography. A special procedure by which a contrast medium is injected into the main cardiac artery. With its help, one can see the interaction of the aorta and the pulmonary artery;
- ultrasound examination of the heart muscle. With the help of echocardiography, one can see the flow between the aorta and the pulmonary artery and evaluate the magnitude of the blood flow in these vessels;
- cardiac catheterization of the heart. The most important study of a patient with suspicion of an open arterial flow. Using a special catheter, which is inserted into a large artery in the upper part of the thigh, the pressure in the vessels of the heart muscle and its cavities is measured. All responsible decisions regarding treatment are made on the basis of catheterization.
So, now you are aware of the dangerous open arterial duct in newborn children, we will consider methods of treatment of the disease.
Treatment
Therapeutic and medicamentous methods
A conservative form of treatment is a non-surgical procedure that is performed in the first days of a small patient's life. The overgrowth of the open arterial flow is associated with the release of lungs by branidectin, a special peptide that cuts the walls of the blood vessel and reduces the flow of blood through it.
Isolation of prostaglandins leads to duct necrosis and neutralization of the action of branidectin. Therefore, doctors artificially introduce into the body of the newborn drugs that block the production of inflammatory hormones. Conservative treatment can be conducted as preparation for surgery in the case of an especially large amount of CAP.
Operation
Surgical operation is the main method of treatment of an open Botallus duct. It is carried out in an emergency, if non-intervention threatens the patient's life. And it has a planned character otherwise. The ideal age of suturing OAP is from two to five years. At this age, the operation passes without consequences for the child and the organism does not have time to change irreversibly. Open operating flow is sewn or special fasteners are placed on it.
The latest developments in the treatment of heart muscle pathologies are not standing still, and cardiac surgeons have learned to close the Botallov passage with the help of X-ray surgical techniques, without opening the chest. In fact, all technology is similar to the procedure for catheterization, which we described above. Instead of a catheter, a probe with a special device is inserted. With it, you can close the hole in the duct of any shape and size.
Summing up the responses of parents who had a child undergoing an operation to close an open duct, you can say that it is not heavy, comparable in complexity with the removal of appendicitis. The main thing is to have time to make it in childhood.
The following video will tell you how the intervention occurs when the Botallus duct is open:
Complications of
In the absence of proper treatment in patients with an open arterial duct, there may be:
- aneurysm and rupture of the duct;
- progression of the disease from white heart disease to blue;
- inflammation of the inner shell of the heart( endocarditis bacterial);
- heart failure;
- stroke;
- unilateral and bilateral pneumonia;
- severe degree of pulmonary hypertension( increased pulmonary artery pressure).
Forecast
In modern medicine, cardiologists do not allow the development of the disease, making surgery in early childhood. But with the refusal of some parents from the operation for religious or other reasons, the probability of a lethal outcome increases several hundred times.
The maximum life span of a person with an open arterial duct is thirty-five years. This period was fixed in the era when the defect could not operate.
The following video will tell in more detail about how occures the Batalov duct with an implant: