An open arterial duct in medicine is called congenital malformation, in which there is a permanent channel that connects two large vessels leaving the heart, that is, the aorta with the pulmonary artery. This channel serves as an integral part for the normal process of blood circulation of the fetus during the period of fetal development, but immediately after birth it quickly overgrows.
Consider the open arterial duct and congenital heart disease in more detail.
Pathology Description
In the case of an open aortic duct from the aorta, blood enters the pulmonary artery. As a result of this, pressure increases in it. Increased pressure negatively affects the pulmonary vessels, which are simply not adapted for such.
Open ductus arteriosus in children is observed quite often.
Such a congenital malformation is often found in premature babies. Thanks to the modern introduction of ultrasound techniques, it is very often detected in children quite quickly. In this regard, at present, it is quite rare to meet a person with this pathology. But it should not be considered that in adults this defect was acquired. The fact is that they simply did not reveal at one time and did not cure the child's open arterial ducts.
The danger of the disease directly depends on the size of the aortic duct, and, in addition, on the degree of damage to the blood circulation arteries, as well as on criteria such as the existence of additional cardiac heart defects and the timeliness of treatment. Given the early detection and implementation of conservative treatment or surgical correction, the prognosis is usually favorable and therefore the pathology can be successfully cured. This problem is mainly dealt with by pediatric cardiologists and cardiac surgeons.
Features of blood circulation in the fetus and aortic duct
The open arterial duct is present in the fetus normally during its intrauterine development. His presence is explained by the fact that the baby at this time does not have the need for blood to pass through the lungs, not taking part in gas exchange. Through the aortic ducts, blood, which is enriched with oxygen in the placenta, from the pulmonary arteries enters the aorta, through which it is already distributed throughout the body.
Immediately after birth, the baby immediately begins to breathe, and its lungs provide oxygen to the body along with the removal of carbon dioxide. Under such conditions, the existence of such a duct becomes more impractical, and that is why it closes shortly after birth.
What are the causes of open duct?
The open ductus arteriosus in children is always present immediately after birth. In most babies, it closes within two to three days, and in premature babies, this process requires a little more time. The exact reasons for which it does not close are not yet known. Doctors believe that the role in its inability to close is played, first of all, by genetic causes, since there are family cases of such a heart defect. But any specific genes that would be responsible for the appearance of this deviation have not yet been discovered. The risk factors for the described pathology include the following reasons:
- The appearance of chromosomal abnormalities, for example, Down syndrome. Similar problems with chromosomes can be caused by factors such as congenital rubella at the beginning of pregnancy, fetal alcohol syndrome, drug use by the future mother, and the like.
- Factor of prematurity of the child. This pathology is often found in premature babies. For example, in eight premature newborns out of a thousand, this anomaly occurs. Among full-term babies, only two cases per thousand newborns are regularly recorded.
- Low birth weight.
- The birth of a baby in a low level of partial pressure of oxygen. Such conditions can occur, for example, at high altitude.
How does CHD and open ductus arteriosus manifest?
Symptoms of deviation
Immediately after the birth of the baby, this pathology does not appear at all. Doctors may suspect the presence of a defect against the background of auscultation of the heart when they listen to heart murmur. Heart murmurs can have a variety of reasons, most of them completely harmless. In the event that the duct does not close within three days, the baby may eventually have symptoms of an increase in pressure in the pulmonary artery. In this case, the following manifestations in the condition of the child will be noted:
- The appearance of rapid breathing and shortness of breath. A premature baby may need oxygen along with assisted ventilation.
- Difficulty in feeding along with insufficient weight gain.
- The appearance of light fatigue.
- The development of increased sweating during exertion, for example, during feeding.
- The presence of an accelerated heartbeat.
- The appearance of a hoarse scream and cough.
- The occurrence of respiratory tract infections.
This symptomatology develops in cases where the duct has a large diameter. Adults for whom this diagnosis has not been established in childhood and appropriate treatment has not been carried out, may have signs of heart failure in the form of shortness of breath, cardiac arrhythmias and limb cyanosis.
With this congenital defect in adults, pulmonary hypertension may develop along with an increase in blood pressure. In more severe cases, such a complication can lead to significant restrictions on physical activity. This can happen to the extent that the simplest daily tasks will simply be impossible to complete.
Diagnosis of the disease
Unfortunately, it is impossible to detect the open arterial duct during intrauterine development, since it is a normal part of the circulation of the developing fetus during gestation. The doctor may suspect the presence of a congenital defect by heart murmur during auscultation of the heart. As part of the diagnosis, the following studies are carried out:
- Performing echocardiography is a painless examination method using sound waves to obtain a real-time image of the heart. At the same time, sound waves are reflected from the baby’s heart, after which they are converted by a computer into a picture. Ultrasound of the open arterial duct allows doctors to clearly see certain problems with the functioning of the heart and its structure. This is the most important technique for a pediatric cardiologist who should diagnose heart disease. Thanks to echocardiography, the size of the aortic duct is determined and the reaction of the heart to its presence is studied. When treatment of this pathology is already underway, this technique allows you to evaluate its effectiveness. The minimum diameter of the open ductus arteriosus is 2 mm, the maximum is 10 mm, and the length is from 4 to 12 mm.
- Electrocardiography is a simple and painless examination method that records the electrical activity of an organ. In children and adults who have not closed the aortic duct, this study demonstrates an increase in heart size.
- Performing oximetry. This is a non-invasive test that is performed without interfering with the body. Thanks to him, the amount of oxygen in the blood is measured. With its help, patients who have a severe form of pulmonary hypertension are identified.
- Radiography is an examination using x-rays to obtain images of the lungs and heart. In the presence of an open arterial duct, an enlarged heart is detected on the radiograph , as well as signs of stagnation in the lungs of the fluid are detected.
- Cardiac catheterization is an invasive test that is performed to detect any other congenital heart defects that have been detected by echocardiography. During the study, a thin catheter directed to the heart is inserted into the groin in the child’s blood vessel. This catheter allows you to measure the pressure of the heart chambers, and also use it to inject contrast, which helps to visualize the aortic duct on an x-ray.
Diagnosis of this defect in adults is almost no different from its implementation in children.
Treatment methods
The open ductus arteriosus is treated with conservative medication. In addition, minimally invasive percutaneous techniques and surgical procedures are used. The goal of the therapy is to close the duct, due to which doctors prevent the development of complications, normalizing the work of the heart. Thus, this pathology can be successfully eliminated.
The open arterial ducts in small infants are often closed independently without treatment. In premature babies up to three months of age, spontaneous closure of the duct is observed in seventy-five percent of cases. In children who are older than three months, doctors observe self-closure quite rarely.
In the event that the aortic duct has a large diameter or causes large health problems, then full-term babies need treatment. Premature babies need treatment for this defect when it leads to heart or breathing problems.
It is interesting to note that for some heart defects, doctors try to keep the aortic duct open, since only with its presence oxygen-enriched blood can mix with venous. In such cases, immediately before the surgical correction of existing defects, they are treated with prostaglandins that keep the aortic duct open.
How is heart disease and open ductus arteriosus treated?
Conservative therapy
Conservative drug therapy is considered effective for premature babies. Given the fact that prostaglandin contributes to the open state of pathology, drugs that inhibit its synthesis can initiate the process of closing the defect. These drugs include non-steroidal anti-inflammatory drugs in the form of "Indomethacin" or "Ibuprofen", which are administered intravenously. These drugs have approximately the same effectiveness.
In the event that a newborn with an aortic duct has symptoms with signs of heart failure, its conservative treatment should include the use of Digoxin and diuretics. True, for absolute cure full closure of the duct is required.
Minimally invasive percutaneous surgery
Minimally invasive interventions are performed using a flexible catheter. It is inserted into the aorta using the femoral artery. Such treatment of the open ductus arteriosus is often used to close the duct in infants or children who are already old enough to correct the pathology. With the help of minimally invasive interventions, treatment of adult patients is most often carried out.
The child is given medications to help fall asleep during the procedure. A doctor catheter is inserted into a large vessel in the groin, and then it is sent to the aorta. When the catheter reaches the desired location, the doctor will insert through it a metal spiral or some other blocking instrument and place it in the aortic duct. Such a device will block the blood flow through the aortic duct.
Carrying out a percutaneous intervention on the heart does not require a chest incision, and it is because of this that the baby's condition is quickly restored. In some countries, the duct closure procedure is performed on an outpatient basis.
Complications after such a treatment technique are rare and are only short-lived. Slight bleeding may occur, and infection may not be excluded in the area of catheter insertion. It is also possible to offset the locking tool from where it was located.
Is open duct arterial surgery necessary?
Surgical operation
An operation to correct the duct is performed for both children and adults in the following cases:
- When in premature or full-term newborn babies, certain health problems arise due to this defect, and the babies, in turn, are still too small to perform minimally invasive intervention.
- When minimally invasive intervention is unsuccessful.
- In the event that the operation is planned to treat concomitant congenital heart disease.
In children who do not have health problems due to this pathology, surgery is carried out mainly after they reach the age of six months. Sometimes doctors perform an operation with a slight defect in order to reduce the risks of infectious endocarditis.
Such operations are always carried out under general anesthesia, that is, the patient is asleep and does not feel pain at all. The surgeon makes a small incision between the ribs of the chest in order to gain direct access to the duct. Then it is closed with clips or stitches.
Complications after such surgery are rare, often they are short-term. They usually include hoarseness, along with diaphragmatic paralysis, infection, bleeding, and fluid accumulation around the lungs.
Postoperative period
Immediately after surgery, the child is kept in the hospital for several days. He is injected with drugs to calm and reduce pain. At the same time, premature babies stay in the medical facility for a little longer, as they often have other health problems. Doctors with nurses teach the child's parents how to take care of him at home. These recommendations include the following tips:
- It is necessary to limit the activity of the child until he is fully restored.
- A regular visit to the doctor for monitoring.
- Compliance with medical recommendations regarding the use of medicines at home.
Absolute recovery usually occurs within a few weeks.
What is the prognosis for open ductus arteriosus?
What is the forecast?
In the event that the baby this pathology was detected in a timely manner and is the only problem associated with the heart, then the prognosis can be said to be excellent. In premature babies, the prognosis of an open duct is often determined by the presence of other health problems. Usually, after closure of the duct, children and adults do not experience any symptoms, and they do not develop any complications.
In adults, the prognosis depends on the health of the vessels and on the state of the myocardium before treatment. If untreated, mortality from the open ductus arteriosus (ICD Q25.0), unfortunately, is twenty percent under the age of eighteen. The older a person with untreated pathology becomes, the more the percentage of possible fatal outcomes increases.