It occurs when the ductus arteriosus development embriogenetskom not close and persisted as a shunt connecting the left branch. pulmonic and aortic usually near the left. subclaviae. The blood comes from the aorta through the ductus continuous systolic and diastolic, it is a form of fistula arterijovenskc how the work of the left ventricle increases. In some patients, obliterative changes in blood vessels in the lungs leading to pulmonary hypertension. In this case, the bi-directional shunt or desnolevi.
The clinical picture
A. The signs and symptoms: no symptoms witness performances left ventricular decompensation. The heart is in the normal range or lakouvećano with strong action at the top. A wide pulse pressure, and diastolic pressure jenizak. To the left, on the edge of the sternum in the first intercostals space idrugom hear a continuous harsh noise "machine", accented ukasnoj systole. Trillo is common. If there is a significant increase in left ventricular present iparadoksalno splitting the second tone.
B. Radiographic findings: heart normalneveličine and contour, but there may enlarge the left atrium and left ventricle. A conspicuous bulge. pulmonary, aorta and left atrium.
C. ECG: normal findings or signs of left ventricular enlargement, which depends on the width of the duct.
D. Special tests: Cardiac catheterization can establish levodesni shunt. The catheter can pass from a.pulmonic through the duct and into the aorta through angiokardiografije possible to exclude the presence of other defects (such as. ruptured sinus Valsalvae right in the heart), which produces a similar sound as the ductus arteriosus perzistens.
Treatment
In the hands of an experienced operative mortality is low (<1%), therefore it is recommended closure duetusa both in children and in adults. Operative mortality was higher in elderly patients. Therefore, we should be cautious in advising surgical intervention, particularly if the patients are asymptomatic and left ventricular hypertrophy have. The greatest risk is subacute bacterial endocarditis.
In the event that there is an indication for pulmonary kipertenzija ligation or cutting duetusa are disputed, but the contemporary view in favor ligging in all cases, while the shunt still levodesni, while pulmonary flow increases, the pressure in a. pulmonic was <100 mm Hg.
Forecast
Floe in early childhood cause high mortality. Smaller shunts are compatible with long-life age. The most common complication was congestive decrease in heart function. You can come up and bacterial endocarditis. A small percentage of patients with pulmonary hypertension and shunt and rcverzni, so the lower extremities, especially the toes cijanotični the normal color of the fingers. In this condition the patient is in surgery.
The clinical picture
A. The signs and symptoms: no symptoms witness performances left ventricular decompensation. The heart is in the normal range or lakouvećano with strong action at the top. A wide pulse pressure, and diastolic pressure jenizak. To the left, on the edge of the sternum in the first intercostals space idrugom hear a continuous harsh noise "machine", accented ukasnoj systole. Trillo is common. If there is a significant increase in left ventricular present iparadoksalno splitting the second tone.
B. Radiographic findings: heart normalneveličine and contour, but there may enlarge the left atrium and left ventricle. A conspicuous bulge. pulmonary, aorta and left atrium.
C. ECG: normal findings or signs of left ventricular enlargement, which depends on the width of the duct.
D. Special tests: Cardiac catheterization can establish levodesni shunt. The catheter can pass from a.pulmonic through the duct and into the aorta through angiokardiografije possible to exclude the presence of other defects (such as. ruptured sinus Valsalvae right in the heart), which produces a similar sound as the ductus arteriosus perzistens.
Treatment
In the hands of an experienced operative mortality is low (<1%), therefore it is recommended closure duetusa both in children and in adults. Operative mortality was higher in elderly patients. Therefore, we should be cautious in advising surgical intervention, particularly if the patients are asymptomatic and left ventricular hypertrophy have. The greatest risk is subacute bacterial endocarditis.
In the event that there is an indication for pulmonary kipertenzija ligation or cutting duetusa are disputed, but the contemporary view in favor ligging in all cases, while the shunt still levodesni, while pulmonary flow increases, the pressure in a. pulmonic was <100 mm Hg.
Forecast
Floe in early childhood cause high mortality. Smaller shunts are compatible with long-life age. The most common complication was congestive decrease in heart function. You can come up and bacterial endocarditis. A small percentage of patients with pulmonary hypertension and shunt and rcverzni, so the lower extremities, especially the toes cijanotični the normal color of the fingers. In this condition the patient is in surgery.
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