In a newborn child, open arterial ducts: manifestations and elimination of pathology

In the early and late neonatal period of a child's life, many decompensated pathologies of his development may appear, including congenital malformations of the formation of various organs and systems.

Such pathological conditions include such AMS as an open arterial duct( OAP), which occurs in 10-18% of newborns, more often in girls.

General

This congenital, related to cardiovascular pathologysystem, is lack of closure of the arterial( botallova) duct , which connects the pulmonary artery and the aorta of the baby during the prenatal period.

What happens if a child has open arterial ducts? The baby begins to form a functioning "vessel" between these anatomical formations, an unnecessary organism that exists outside the mother's womb, that

Causes and risk factors

Knowledge of the etiological factors contributing to the non-spread of this fetal communication is especially important not only for doctors but also for future mothers, so that they can in any case suspend anxiety and seek medical help in time. Also, this knowledge is equally important for the prevention of the emergence of OAAs.

However, some factors can affect its infection. :

1. Infectious factor( herpes viruses, CMV, mumps, influenza, herpes, rubella, enterovirus or Coxsackie virus in the first third of the fetal period) are the main causes of the open ductus arteriosus and congenital heart defects of the newborn .
2. Chronic extragenital maternal pathology( diabetes mellitus, hypothyroidism and other diseases).



3. Abnormally proceeding pregnancy with the development of an early toxicosis or a threat leading to its premature interruption.
4. Heredity( if there is a congenital, non-infected arterial duct in the mother or near relatives of the child).
5. The effect of toxic compounds during pregnancy( chronic alcoholism, occupational hazards in the mother, nicotine intoxication, drugs, some medicines).
6. OAA in the structure of chromosomal diseases( Shereshevsky-Turner syndrome, Patau, Down, Edwards).
7. The mixed effect of the above factors.

Types and phases of the

flow. Isolated OAD, which occurs in approximately 10% of all cases of of this defect, is combined with other heart defects( atrial septal defect in children, aortic coarctation in newborns, and pulmonary arterial stenosis).

It is also customary to classify open as for its development phases :

• 1 stage is called "primary adaptation" and lasts for the first 3 years of life of the baby. This is the most intensive stage of clinical symptoms, which can even lead to death if you do not provide suitable surgical treatment.
• Stage 2 of the is characterized by a relative compensation of the clinical picture of the disease and lasts 3 to 20 years. A decrease in pressure in the vessels of the small( pulmonary) circle of blood circulation and an increase in pressure in the cavity of the right ventricle develop, which leads to its functional overload when the heart is working.
• In the 3 stages , irreversible vascular sclerosis in the lungs progresses, which causes pulmonary hypertension.

Given the level of pressure in the lumen of the pulmonary artery and pulmonary trunk, distinguishes the following degrees of OAS :

1. When the systolic pressure of the pulmonary artery is not more than 40% of the arterial pressure of the body.
2. Presence of symptoms of moderate hypertension in the pulmonary artery( 40-75%).
3. When there are symptoms of severe hypertension in the pulmonary artery( over 75%) and there is blood flow from left to right.
4. When severe hypertension develops in the pulmonary vessels, and pressure equal to systemic arterial pressure, promotes blood flow from right to left.

Than dangerous: possible complications

• Development of endocarditis of a bacterial nature, leading to damage to the inner layer of the wall of the heart chambers, especially in the area of ​​the valve apparatus.
• Bacterial endarteritis.
• Myocardial infarction with risk of rhythm or death.
• Heart failure of varying severity.
• Pulmonary edema due to increased pressure in the pulmonary vessels, which requires extremely fast action on the part of medical personnel.
• The rupture of the main vessel of the human body - the aorta.

Symptoms

Symptoms manifested in this form of congenital heart disease, entirely depend on the degree of hemodynamic changes in the body .In certain cases, the clinical picture will not be traced.

In others it progresses to the extreme degrees of gravity and manifests itself in the development of the "heart hump"( convex deformation of the anterior chest wall in the area of ​​the projection of the heart), the movement of the apical impulse of the heart downward along with the expansion of its zone, the trembling of the heart in its lower and leftdepartments, persistent shortness of breath with the position of orthopnea and pronounced cyanosis.

The main symptoms of OA in less severe clinical cases are :

• increased heart rate;
• rapidity of breathing;
• enlargement of the liver( hepatomegaly) and spleen;
• electrocardiographic signs of an increase in left divisions;
• specific noise in auscultation of the heart in the second left intercostal space near the sternum( systolic-diastolic);
• rapid pulse on the radial arteries;
• increase in the level of systolic system pressure and a decrease in diastolic( sometimes to zero).

When to contact a doctor

Not in every case, parents can notice changes in their child's health status and suspect this congenital pathology, which certainly worsens the prognosis for the baby.

Parents should remember that a trip to the doctor is necessary if they revealed the following symptoms in their baby:

• disturbance of the rhythm of sleep;
• drowsiness;
• slow increase in body weight;
• shortness of breath at rest or after minor exertion;
• cyanotic skin tone after exercise;
• lethargy, refusal of games and entertainment;
• frequent ARI and SARS.

Your treatment should be made by to the district pediatrician , who can send in case of pathological symptoms to a consultation with other specialists: to a pediatric cardiologist, a pediatric cardiosurgeon.

Diagnosis

Diagnosis of an open botulian duct involves several groups of methods of investigation. At objective research of the child the doctor can define:

• the quickened pulse;
• increased systolic pressure while decreasing diastolic pressure;
• changes from apical impulse;
• enlargement of the boundaries of cardiac dullness( cardiac boundaries);
• the above described Gibson noise( systolic-diastolic);
• anamnestic symptoms associated with possible exposure to risk factors for this blemish.

Among the instrumental diagnostic techniques, the following are actively used:

1. ECG( electrocardiography) .There is a tendency to hypertrophy of the left heart, and in the more severe stages and right divisions with a deviation of the cardiac axis to the right. As the disease progresses, there are signs of a violation of the rhythm of the contractions of the heart.
2. Echocardiography of the .Also gives information on the expansion of the left heart cavities. If you add a Doppler study, you determine the mosaic pattern of blood flow through the pulmonary artery.
3. Radiography of the of the thorax. Characteristic increase in the contours of the pattern of the lungs, an increase in the transverse size of the heart due to the left ventricle with the initial stages of manifestations of symptoms of OA.If the hypertension of pulmonary vessels develops, the lung pattern, on the contrary, is impoverished, the pulmonary artery trunk swells, the heart is enlarged.

Differentiation of the diagnosis is necessarily carried out with other congenital heart defects, such as:

• combined aortic defect;
• incomplete atrioventricular canal;
• defective ventricular septum;
• defective part of the aorta and pulmonary artery.

Treatment

The conservative treatment method is used only in preterm infants and consists in the introduction of inhibitors of prostaglandin formation in order to medically stimulate self-closure of the duct.

The main drug in this group is Indomethacin .If the triple repeat of the drug in children older than three weeks of age is not effective, then surgical obliteration is performed.

Surgically babies are treated at the age of 2-4 years old , this is the best period for this type of therapy. In the expanded application there is a method of bandaging the botulinum duct or its transverse intersection with the subsequent sewing of the remaining ends.

Prognosis and prophylaxis of

In untreated ducts, death occurs in people aged around 40 due to the development of severe hypertension in the pulmonary arteries and severe degrees of heart failure. Surgical treatment provides favorable outcomes in 98% of small patients.

Preventive measures:

1. Exclusion of smoking, alcohol abuse, drugs.
2. Avoiding stress.
3. Mandatory medical and genetic counseling both before and during pregnancy;
4. Sanitation of foci of chronic infection.

The open arterial duct is a serious congenital pathology of , which carries high mortality rates in untimely or inadequate treatment.

The debut of his clinical picture is the development of signs of pulmonary hypertension and heart failure. However, if diagnosed in time for this disease, its outcome is very favorable , which is confirmed by modern statistical data.