Ductus arteriosus persistens

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. 

Ductus arteriosus persistens

This is the persistence of fetal defects between channels descendentnog of the aorta and pulmonary artery, which in fetal life necessary for the maintenance of fetal circulation, and in the postnatal period, his persistiranje an anomaly that allows direct communication between the systemic and pulmonary blood flow at the level of large blood vessels.

Types of diseases

The width and length, and may differ functionally:

• regular transient arterial channel

• with high pulmonary flow,

• with pulmonary hypertension.

Symptoms and diagnosis

• asymptomatic, discovered incidentally at the heart of a forest.

• It occurs early in heart failure, frequent respiratory infections.

• Cyanosis, dyspnea on exertion, frequent respiratory infections.

Clinical signs of

• A continuous thrill in mterkostalinom II (ir) area to the left, continuous noise also in part II ik left, top hiperdinamičan heart attack.

• With the above findings hear diastolic drip on top.

• Cyanosis, maljičasti fingers II of the pulmonary artery tone accent, noise is not continuous, systolic or diastolic dominant component.

Rtg

• The heart is normal size. Pulmonary vascular pattern is normal or slightly increased.

• The heart is increased at the expense of the left atrium and left ventricle. There are a plethora of lung and pulmonary artery pulsation at the same time, the left ventricle and aorta.

• The heart is a whole increased. There is an increase of right ventricle, left ventricle, left atrium. Pulmonic arch was bulging, full of the hilum, a peripheral light.

ECG

• In the normal limits.

• Left ventricular hypertrophy, left ventricular hypertrophy.

• Left ventricular hypertrophy, hypertrophy of both chambers with a predominance of the right ventricle with right bundle branch block, or without it.

Cardiac catheterization

In cases with typical auscultatory findings, catheterization is not required. It shows

left-right shunt at the level of large blood vessels, ie. oxygen saturation was higher in the pulmonary artery than in the right chamber.

In the hypertensive form of increased systolic pressure in the right ventricle and pulmonary artery.

The characteristic course of the catheter, which can pass from the pulmonary artery into the aorta through the channel.

Angiokardiografija

Angiokardiografijom retrograde passage receives the image contrast from the aorta into the pulmonary artery.

Functional characteristics of

Through transient arterial canal, a portion of blood from the aorta back into the pulmonary artery, pulmonary blood volume burdensome circulation, left atrium and left ventricle.

If the channel is larger blood volume, which burdens the pulmonary circulation can be a very early lead to left ventricular failure. If the channel is short and wide, there is a direct transfer of systemic (aortic) pressure in the pulmonary artery, ie. produces pulmonary hypertension, which prevents involution of fetal pulmonary arteries and the structure immediately after birth leads to the reversible pulmonary hypertension.

During his lifetime, as in ventricular septal defect, leads to lung damage intima of blood vessels and the formation of irreversible pulmonary hypertension.

Forecast

In today's level of development of medical prognosis in these patients is good. Today, every patient with transient arterial duct, which is complicated by irreversible pulmonary hypertension, surgically treated with success.

The most common complications include heart failure, pulmonary hypertension and subacute bacterial endocarditis.

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