Patent ductus arteriosus: symptoms, diagnosis, treatment
Patent ductus arteriosus, despite the alarming name, refers to the white vices. The disease is be treated with medication and through surgery quite well, and at an early age. The operation belongs to the category of uncomplicated, since the heart itself this in no way affected.
Delay treatment, and even more to refuse it, impossible: the longer your heart works with this load, the more severe the complications.
The origin of the disease
The fetus in the womb of the mother, of course, is not breathing: his lungs are compressed and filled with fluid. At this time he receives oxygenated blood from the mother. The body receives blood from the right ventricle, including to the lungs, which at this point are the only consumer of oxygen, and not the supplier.
Patent ductus arteriosus acts as a pile between the pulmonary artery and aorta. Because of the high pressure compressed in the lungs the blood sent there with some difficulty, but because of the ability to regulate blood flow to individual organs of the ventricle is not, then the payment is made to other, mechanically. The excess blood is excreted through the ductus arteriosus from the pulmonary artery directly into the aorta.
Thus the right ventricle is protected from overload, and the blood, bypassing the pulmonary circulation, from moving in the large.
When the newborn takes the first breath, the lungs are freed from liquid and straightened. Accordingly, the pressure in them falls, the pulmonary vascular resistance decreases and blood begins to circulate normal for the human body method. The need in the cap disappears.
In normal cases of patent ductus arteriosus in children is closed in the first 15-20 hours and finally heals within 2-8 weeks (but not more than 15) into a strand of connective tissue. In premature infants, PDA can be maintained longer.
If within 3 months from the moment of birth the child duct remains open, we should talk about the pathological course of the disease.
The development of the disease
Diagnosis of PDA, on the one hand, simple, as for a precise definition of enough available such a method as ultrasound and Doppler. With the other babies additional research only subjected, if necessary, if there are grounds for suspicion.
AOP, especially if the width of the duct neskryvaemoy small, asymptomatic and is often detected at random when conducting the treatment of other diseases - pneumonia, bronchitis and others.Latest with this diagnosis are accompanying diseases.
In the fetus the difference between the pressure in the pulmonary artery and the aorta causes the discharge of the blood from left to right, facilitating the work of the right ventricle. In adults with a wide AOP pulmonary resistance increases, and the discharge of the blood changes direction from right to left, i.e., in the pulmonary circulation gets more blood, overflowing lung tissue.
If a narrow AOP without changing the discharge of the blood, disease may not display any signs. In General, this option does not affect life expectancy. In women with narrow and medium cap to the left to the right, even the pregnancy proceeds without complications. Dangerous disease is considered because of the increased risk of endocarditis of infectious origin.
Another picture is observed when changing the discharge of the blood. To cope with the excess liquid left ventricle of the heart is forced to work at too intensive, and in the blood vascular of the lungs to compensate for the increased pressure. In the end, in the lungs develops the stagnation of blood and the left ventricle hypertrophied. The longer this takes, the greater the deformation of the exposed heart and lungs of the child.
These overloads are accompanied by all the relevant inflammatory diseases - the same bronchitis, colds, pneumonia, as a small patient susceptible to such illnesses due to poor outflow of blood from the lungs. Treatment of only these external manifestations of little. However, by six months the child has other symptoms that suggest ARS and to conduct additional studies.
The most serious consequences of the disease include tracking complications:
- Heart failure is the development of it is obvious, since the left ventricle works with high load, which accordingly leads to disturbances in the heart.
- Pulmonary edema - the last stage of stagnation of blood in the lungs. However, if you ignore treatment, it is possible for the complication.
- Infarction - necrosis of areas of the heart that is extremely dangerous for children and adults.
- Aneurysm - expansion of the open duct and the gap. Possible damage to and rupture of the aorta, which is incompatible with life.
- Bacterial endocarditis - inflammation of the inner sheath of the heart, is fraught with disruption of valves and other complications.
To avoid all these consequences it is possible, timely treatment. And with a small duct width up to 4 mm, and early stages of detection, treatment can be carried out medically, with the use of drugs that stimulate closure. Surgical intervention is usually taken for achieving one year of agechild.
The reasons for the formation of the AOP
Patent ductus arteriosus refers to the most frequent diseases and is 6.1% of all violations. However, the causes of the disease is not established.
Several factors are identified that contribute to the formation of defect:
- Ionizing radiation - x-ray research work in the radiology Department and so forth, cause gene mutations, and those, in turn, cause a variety of pathologies.
- Chemical mutagenic factors - phenols, nitrates and so on. Negative impact and those that stand out when smoked, absorbed with alcohol and other.
- Diseases associated with metabolic disorders, particularly sugar, and the immune system: diabetes mellitus, systemic lupus erythematosus. The same effect moved to 4-8 weeks pregnant infectious disease - herpes, rubella, influenza.
- Genomic pathology.
- Premature birth - underweight, lack of development, oxygen starvation of the fetus and so forth provoke an AOP. Prematurity is considered the most main factor influencing the disease.
According to the statistics the risk of AOP the female child is higher in 2 times than the male child.
Symptoms of AOP
Signs of disease in a child is not straightforward: the symptoms are uncharacteristic, but since, in General, indicate any violations of, the disease, in the end, and is detected during diagnostics. If the width of the open duct are small, and the above symptoms may not occur.
Cap the child is accompanied by the following signs:
- poor weight gain or even weight reduction;
- fatigue, passivity, unwillingness to participate in active games;
- shortness of breath, heart palpitations even at low loads;
- bluish discoloration of the skin after active movements, after crying or shouting
- cough, hoarse voice, regardless of the time of year;
- frequent colds and bronchial disease, pneumonia.
The symptoms in adults are also uncertain. Narrow AOP may not Express themselves completely. With a wide duct and the discharge of the blood from left to right there are all signs of heart failure and pulmonary hypertension:
- shortness of breath and fatigue;
- attacks of suffocation at night;
- enlargement of the liver, ascites, jugular vein as a consequence of hypertension of the lungs;
- when changing the discharge of the blood may manifest a local cyanosis of the legs, rapid fatigue compared to the rest of the body.
If a narrow AOP can be considered relatively safe - white, Vice, subject to the discharge of the blood from left to right, medium and wideAOP with discharge of blood from right to left reduces life up to 40, and even 25 years, as accompanied with development of cardiac and pulmonary insufficiency. Treatment is necessary and possible at any age.
Diagnosis of the disease
Newborns patent ductus arteriosus may be suspected if, within two or three first days of life the child does not stop a heart murmur.
For the purpose of diagnosis and prescribed an x - ray- it shows the change of the lung tissue and the vascular bundle, as well as ultrasound and echocardio, which secures the hypertrophy of the left ventricle of the heart and help to determine the direction of discharge of the blood.
For the final confirmation of the diagnosis is carried out probing: the probe is introduced into the pulmonary artery and watching its movement.
Practically the same methods are used in the diagnosis of an older child or adult.
- Ultrasound not only establishes the presence of an open duct, but also provides information about its width. In addition, ultrasound identifies other accompanying disorders that often.
- Doppler ultrasound will be scheduled in parallel, it can help establish the exact quantity of blood.
- Radiography - allows you to define the size of the heart and damage lung tissue.
- Electrocardiography is not a very accurate method, since the narrow RFP no change method does not fix. With a more severe course of the disease is recorded thickening of the left ventricle and atrium.
- Catheterization - a catheter is inserted into a vein or artery, and allow for very accurate diagnosis of any heart defect. The catheter used for ductal closure.
In General, diagnosis of the disease does not cause difficulties.
Treatment of AOP
Medication is usually administered to newborns to cause spontaneous closure of the AOP. For this purpose, anti-inflammatory drugs that block the production of prostaglandins. These include Ibuprofen and Indomethacin. Antibiotics can be prescribed if there is a risk of pneumonia and endocarditis.
The most effective medication will be during the first two weeks of life the newborn. Later method is used if a narrow AOP is not more than 4 mm and the absence of violations in development.
Doctors strongly recommend not to abandon the operation and close the open duct in children 2 to 5 years. Defect even under the most favorable conditions impact on the cardiovascular system and respiratory system and contributes to wear.
The closure of the AOP is performed by two main methods.
- Catheterization is less traumatic, applies to patients of any age. Its essence is this: through incisionhip vein catheter, which delivers to duct occluder or coil. The latter covers the duct, and the circulatory system is fully restored.
- The ligation of the duct - an open surgery, performed under a wide AOP and in the presence of signs of heart failure. The optimal age to 3 years. But if necessary, the operation is carried out at any age.
If no comorbidities or complications treatment leads to a complete, absolute recovery.
Patent ductus arteriosus is one of the few pathologies in which the possibility of complete recovery. Of course, the result of surgery or medical course, the better, the earlier treatment is started: the pathology causes changes in the heart and lungs, but these complications are treatable worse.