The human blood supply system includes the main organ, heart and arteries emerging from it, returning back from the veins from the tissues. Its proper functioning is determined by the normal anatomical structure and hemodynamic conditions. In case of violation of one of these two conditions, damage to the blood supply to the remaining organs also occurs.
Relevance
Unfortunately, the frequency of congenital malformations is increasing every year. This is primarily due to the deterioration of the environmental situation and the health disadvantages of the parents themselves. As pediatricians teach, you need to start preparing for the birth of a child from your childhood, meaning that both spouses must carefully take care of themselves when planning a family. So, for a long time before pregnancy, you should abandon bad habits, cure chronic diseases, expectant mothers to correct eyesight, nutrition, normalize rest. However, there are still such cases when children with congenital malformations are born in a healthy family. Therefore, at different periods of gestation, a woman must periodically undergo an ultrasound examination, which allows to identify intrauterine fetal disorders. But even the diagnosis of such a process does not mean the need for an abortion, because medicine does not stand still, and at present, most congenital malformations are treated. One such striking example is the non-obstructed arterial (Batalov) duct.
Duct functions
The
circulatory system of the
fetus is significantly different from that of an adult. This is due to his special nutrition during prenatal development - through the placenta from the mother’s blood into his own blood all the substances necessary for growth, including oxygen, are supplied to him. Therefore, the need for a respiratory and digestive system for the period before birth is simply absent, while the cardiovascular system works in an enhanced mode. One of its most important features is
an oval window in the interatrial septum and Batalov duct. Using the last aorta, it connects to the trunk of the pulmonary artery, and so the mother’s blood, bypassing the pulmonary vessels, enters the large circle of the fetal circulation. Normally, in the first hours of a baby’s life, when his lungs are straightened, and he begins to breathe on his own, he should stenose, and during the first days - completely obliterate and turn into a bundle. However, if this does not happen, and the Batalov duct remains open, then severe hemodynamic disturbances occur in the child’s blood supply system.
Etiology
There are three main reasons for this malformation. The first is another congenital pathology with which the open Batalov duct combines, for example, Down syndrome or tetralogy of Fallot. The second is a severe course of labor with complications leading to fetal hypoxia or asphyxiation. This may be their slowness, prolonged standing of the head above the entrance to the pelvis, premature discharge of amniotic fluid, the occurrence of an ascending infection, entwining of the neck with an umbilical cord or obstruction of the airways with fetal membranes, and many others. And finally, the third is initially, i.e. in utero, an abnormally wide or long Batalov duct formed due to the influence of factors from the mother on the child during the laying of the heart, that is, in the first 10 weeks of pregnancy. So, many drugs possess teratogenic properties, especially hormones, sleeping pills and antibiotics, viruses, alcohol, smoking, and stressful situations. But before this time, a woman should be surrounded by exceptional care and be in a state of physical and psycho-emotional rest.
Pathogenesis
Hemodynamic disturbances in such a congenital
heart disease as Batalov’s duct non-closure are caused primarily by the discharge of blood from the aorta into the pulmonary trunk due to a pronounced pressure gradient. As a result, the pulmonary circulation becomes overloaded, and stagnation develops gradually in it, followed by sweating of the liquid part of the plasma into the surrounding tissues. The lungs become easily susceptible to infections, become unable to properly enrich the blood with oxygen. At the same time, due to a decrease in the volume of circulating blood in a large circle, it becomes depleted, all organs suffer from severe hypoxia, and since the baby’s body grows with maximum intensity during the first year, they require a lot of nutrients and energy. And because of this deficiency, their dystrophy increases, as a result of which their functioning suffers. The child slowly gains weight, is often sick, becomes restless, constantly screams.
Operation
However, the method of treating this pathology is not so complicated, because the only Batalov duct remains the only problem. The operation becomes the only option for his therapy, because conservative methods do not affect him. Surgical correction of the defect is usually carried out at 5-10 years, but 3-5 years is considered the best age for this. The main thing is that this happens before puberty, when the hormonal background of the body is rearranged, and it will need more blood supply. There is evidence of isolated cases of treatment in adulthood after a late diagnosis of the defect. During the operation, the Batalov duct is simply sutured or ligated with extravascular access from the femoral artery for the least trauma to the baby’s tissues. All this happens under the control of angiography and with the help of endoscopic devices. Such a mini-operation is already actively developed by surgeons and is not complicated.
Forecast
After treatment, the disease has a favorable outcome, life expectancy usually does not suffer. This depends on the stage of compensation of the defect at the time of its detection and on the degree of changes in the vascular system of the lungs. However, gradually such patients develop severe heart failure, often complicated by infectious endocarditis. Even isolated cases have been described when unoperated patients survived to 70-80 years due to small deviations of the ductus arteriosus and strong compensating ability of their body.