The reasons for the formation of an open arterial duct, the methods of diagnosis and treatment

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2017.06.27
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Heart diseases

One of the least "severe" heart defects is the open arterial duct in children or adults. This problem has many variants of invasive or non-invasive treatment, which makes it possible to select a suitable method for the patient to treat the defect. Note that only children born in the world have an open arterial duct - this is not a pathology, but a norm. If properly developed, it will close for 2-3 weeks and will not be recalled in the future. However, there are children whose duct does not close even after three weeks. What to do in this case, and what is worth preparing for parents - later in the article.

Content

  • What is an open Botallov duct?
  • Discoveries of the pulmonary-cardiac arterial duct: what is its danger?
  • Symptoms in the open arterial duct in children
  • Diagnosis of open arterial flow
  • Open the arterial duct: what is the therapy
  • Recovery after surgery
  • Why is the arterial duct not sealed?

What is an open Botallov duct?

Congenital heart disease, which is the continuation of the functioning of an additional vessel between the aorta and the pulmonary trunk, is one of the most common.

In the intrauterine period of Botall's development, the duct is needed to supply the fetus with blood from the mother's body. When the lungs are not functioning yet, and there is no access to oxygen, this duct is the connecting element for communicating the circulatory system and the airways. Throughout the pregnancy through it comes everything necessary for the life of the fetus. Immediately after birth, when the baby takes the first breath, the body starts the process of closing (obliteration) of the duct.

Botallov duct

Usually this way for blood should disappear within three weeks after the birth of the child. During this time the body will develop a special substance - bradykinin. It provokes narrowing of the duct, gradually turning it into a simple ligament. If, after the above-mentioned time, the Botallov duct is not inflated, then we can talk about the formation of heart disease. This pathology is typical for premature infants.

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Important! The degree of danger of this CHD (congenital heart disease) depends on the width of the duct.

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In preterm children, the open arterial duct is treated medically, by introducing special drugs that stimulate its closure. This does not always help. In such cases, surgical intervention is indicated. Thus doctors try to wait, when to the patient it will be executed even three years. It happens that as the body grows, the body begins to independently produce the desired substance, and the duct is obliterated.

Discoveries of the pulmonary-cardiac arterial duct: what is its danger?

As already mentioned above, Botallov duct in children who have just appeared in the world - this is the norm. Doctors without problems give babies to their parents and do not keep them until the closure of the duct. Often the latter are neglected by a preventive visit to the cardiologist and are limited to general examination and vaccination. This approach to the health of children is unacceptable, since it can lead to a serious threat to health and even life.

Circulation of blood in OAPA

Normally, the vessels of the large and small circle do not interfere with each other's functioning. In both systems, a certain pressure remains, venous blood does not mix with the arterial blood. If the closure of the arterial duct does not occur:

  • increased pressure in the circulatory system;
  • the heart increases to cover the load;
  • the direction of the blood flow can change.

All this violates the scheme of functioning and blood circulation and, although the body adapts to the additional load, the heart muscle wears out faster. The average age of people with this diagnosis is only 40 years.

By increasing the size of the heart, deformation of the chest and displacement of internal organs are possible. With age over the heart formed a noticeable hump, which becomes a characteristic sign of the disease.

This congenital heart disease imposes certain restrictions on physical activity, nutrition, the acceptability of taking certain medications.

Symptoms in the open arterial duct in children

In adolescence or older age, a person himself understands that he has heart problems. Children aged three years or less react only crying for pain and severe discomfort, so parents should pay attention to the following symptoms:

  • pulse more than 150 beats in 60 seconds;
  • constant shortness of breath;
  • lethargy, fatigue;
  • poor sleep;
  • delay in growth and physical development.

A slow increase in weight or a clear reluctance to participate in mobile games can also signal that the arterial duct has not closed.

As a rule, 50% of preterm and about 2% of full-term children suffer from an unclosed arterial duct. In this case, the newborn may not have obvious signs: the skin will be without a cyanotic shade, and when listening to the attending physician can hear only weak noises. In order not to make a mistake and find a threat in time, there are many ways. About what methods are used for diagnosis - next.

Diagnosis of open arterial flow

There are many ways to diagnose the activity of the cardiovascular system, but not every method will allow to see if the arterial duct is closed. The list of available methods and their effectiveness are below:

  • electrocardiography - rarely shows disturbances, only at the stage of pathological changes;
  • Radiography - shows augmentation of heart and an overflow of veins and arteries by blood;
  • angiography - tracks the direction of blood flow;
  • phonocardiography - reveals characteristic noises in the heart;
  • echocardiography (ultrasound) - gives the most detailed report on internal processes, allows visualization of the duct;
  • catheterization - focuses on the pressure and oxygen saturation of blood in the vessel;
  • computer tomography - shows the size and location of the arterial duct.
X-ray of a baby with a PDA

Each of the ways has its advantages. Therefore, with the initial diagnosis, you can do more affordable methods. If the arterial duct is not closed, the results will show. A more detailed and, accordingly, expensive examination should be carried out with confidence in the presence of violations.

Based on the data received, the attending physician can determine the extent of the problem, how much the arterial duct violates hemodynamics. On this basis, recommendations are issued and prescriptions are made.

Any open arterial flow must be eliminated. The more dangerous the untimely detected defect is - described above. Early intervention will help to avoid unpleasant consequences.

Open the arterial duct: what is the therapy

A small open arterial duct of 2 mm does not pose a serious threat and may well be observed accompanied by medical treatment. As preparations used:

  1. Inhibitors of cycloxygenase. In fact, it is anti-inflammatory, which affects the amount of substance that prevents the fusion of the duct. It is administered intravenously.
  2. Diuretics. Needed to facilitate the work of the heart muscle. They produce a diuretic effect, thereby reducing the amount of arterial blood.
  3. Cardiac glycosides. Lengthen the diastole, thereby giving the heart more time to rest.

This course of treatment of duct defect is repeated no more than twice. During this time, the Botallov duct in children should disappear. Such an approach to treatment is desirable for children who have not reached the age of three - before this age, surgical intervention is highly undesirable.

Only if non-invasive methods have given results, an operation is scheduled to close the duct. The specified method is shown for:

  • no effect of drugs;
  • the entry of blood from the aorta into the blood supply system of the lungs;
  • stagnation of blood;
  • increased pressure in the pulmonary artery;
  • frequent respiratory diseases;
  • heart failure and other disorders.

Eliminating OAA surgically is not always possible. Thus, the ingress of blood from the lungs into the aortic segment of the blood supply is a sign of fundamental disorders in the functioning of the organism. To treat it it is necessary on a special program - it is written out by the doctor, proceeding from the patient's data.

Important! At an early age, an open arterial Botallov duct is eliminated simply. The optimal age for surgery is 3-5 years.

The invasive process itself can be of two types:

  1. Endovascular. A special instrument is introduced through a large vessel. It installs a special plug (occluder), which blocks the unwanted channel. This is the least traumatic interference.
  2. Open. A small incision is made, through which the pathology is eliminated. Such a ligation of the open arterial duct will lead to a gradual overgrowth of the defect.

It must be said that it is possible to relapse the opening of the duct in the baby, most often during puberty, when the body manifests itself is rebuilt.

Recovery after surgery

If it is not possible to manage non-invasive and minimally invasive methods, it is worthwhile to understand what the operation is to eliminate the imperfection of the arterial duct. Before it will be made all the necessary tests and clarified the presence of hereditary diseases and personal intolerance. After the intervention, the patient is transferred to the intensive care unit. Within a day he departs from anesthesia. At the same time, pressure, heart rate, and general well-being are carefully recorded. The patient is connected to an artificial respiration apparatus, so that during the day it will not be possible to speak.

Newborn after surgery

If there are no warning signs, on the second day the patient is transferred to intensive therapy. The first days prescribed strict bed rest, but from the second day you can do gymnastics brushes, feet, hourly conduct breathing exercises. It is important not to miss the dressing and wound treatment. The speed of recovery depends on the characteristics of the body. However, in most cases, after 5-7 days the patient is discharged home. The tightening corset, which does not allow sutures to disperse, should be worn as long as the doctor says. This will allow the wound to grow faster and relieve extra blood loss.

Since human performance is impaired, it is recommended to call for help for a while to help the au pair.

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Important! The wound should be treated with anti-inflammatory and bactericidal agents like green. After healing, it is allowed to apply an antifungal ointment.

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In the first month, physical exertion for people with an open arterial duct is severely limited, but one can walk leisurely up to 200 meters. When discharging the doctor gives advice on exercises and diet. If the recommendations are observed, a full recovery is possible after a month.

Why is the arterial duct not sealed?

The reasons for which there is an openness of the arterial duct, there may be several:

  • early appearance on the light (up to 37 weeks);
  • hypoxia in childbirth;
  • chromosomal diseases;
  • underdevelopment of the muscular layer;
  • elevated levels of prostaglandins.

It should be noted that the open arterial duct in the child is possible if the mother is pregnant and has suffered rubella or other infectious diseases. Negatively affects the fetus:

  • alcohol consumption;
  • smoking;
  • taking hormonal drugs;
  • use of sleeping pills.

Any toxic substance that gets into the mother's body can lead to developmental disorders, in particular, to the absence of a septum between the aorta and the pulmonary trunk.

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Important! Specify the presence of such pathologies when registering!

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Remember that only regular monitoring of the condition and following all recommendations will avoid irreversible processes and the appearance of new defects in the arterial duct.

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