- a functioning pathological communication between the aorta and the pulmonary trunk, which normally provides embryonic blood circulation and is subject to obliteration in the first hours after birth. A patent ductus arteriosus is manifested by a child’s developmental delay, increased fatigue, tachypnea, palpitations, interruptions in cardiac activity. Data from echocardiography, electrocardiography, radiography, aortography, and cardiac catheterization help diagnose patent ductus arteriosus. Treatment of the defect is surgical, including ligation (ligation) or intersection of the patent ductus arteriosus with suturing of the aortic and pulmonary ends.

ICD-10

Q25.0

General information

Patent ductus arteriosus is a non-closure of the accessory vessel connecting the aorta and pulmonary artery, which continues to function after the period of its obliteration has expired. The ductus arteriosus (dustus arteriosus) is an essential anatomical structure in the embryonic circulatory system. However, after birth, due to the appearance of pulmonary respiration, the need for the ductus arteriosus disappears, it ceases to function and gradually closes. Normally, the functioning of the duct ceases in the first 15-20 hours after birth, complete anatomical closure lasts from 2 to 8 weeks.

Complications of patent ductus arteriosus can include bacterial endocarditis, ductal aneurysm and rupture. Average duration life during natural course the duct is 25 years. Spontaneous obliteration and closure of the patent ductus arteriosus occurs extremely rarely.

Diagnosis of patent ductus arteriosus

When examining a patient with an open ductus arteriosus, a deformation of the chest (cardiac hump) and increased pulsation in the projection of the apex of the heart are often revealed. The main auscultatory sign of a patent ductus arteriosus is a rough systole-diastolic murmur with a “machine” component in the second intercostal space on the left.

The mandatory minimum of studies for an open ductus arteriosus includes chest x-ray, ECG, phonocardiography, and ultrasound of the heart. X-ray reveals cardiomegaly due to an increase in the size of the left ventricle, bulging of the pulmonary artery arch, increased pulmonary pattern, and pulsation of the roots of the lungs. ECG signs of patent ductus arteriosus include indications of left ventricular hypertrophy and overload; at pulmonary hypertension– hypertrophy and overload of the right ventricle. By using

Treatment of patent ductus arteriosus

Conservative management of patent ductus arteriosus is used in premature infants. It involves the administration of prostaglandin synthesis inhibitors (indomethacin) to stimulate spontaneous obliteration of the duct. If there is no effect from repeating the drug course 3 times in children older than 3 weeks, surgical closure of the duct is indicated.

In pediatric cardiac surgery for patent ductus arteriosus, open and endovascular operations are used. Open interventions may include ligation of the patent ductus arteriosus, its clipping with vascular clips, division of the ductus with suturing of the pulmonary and aortic ends. Alternative methods Closing the patent ductus arteriosus is its clipping during thoracoscopy and catheter endovascular occlusion (embolization) with special coils.

Prognosis and prevention of patent ductus arteriosus

A patent ductus arteriosus, even of small sizes, is associated with increased risk premature death, since it leads to a decrease in compensatory reserves of the myocardium and pulmonary vessels, joining serious complications. Patients who have undergone surgical closure of the duct have better hemodynamic parameters and longer life expectancy. Postoperative mortality is low.

To reduce the likelihood of having a baby with a patent ductus arteriosus, it is necessary to exclude all possible risk factors: smoking, alcohol, taking medications, stress, contact with infectious patients, etc. If close relatives have congenital heart disease, genetic consultation is necessary at the stage of pregnancy planning.

Patent ductus arteriosus (PDA): causes of non-occlusion in children, symptoms, how to treat

Patent ductus arteriosus (PDA) is a disease that occurs as a result of disruption of the normal development of the heart and great vessels in the prenatal and postnatal period. Congenital ones usually form in the first months of fetal development as a result of atypical formation of intracardiac formations. Persistent pathological changes in the structure of the heart lead to its dysfunction and development.

Arterial (Botallov) duct- a structural formation of the fetal heart, through which the blood ejected from the left ventricle into the aorta passes into the pulmonary trunk and returns again to the left ventricle. Normally, the ductus arteriosus undergoes obliteration immediately after birth and turns into a connective tissue cord. Filling the lungs with oxygen leads to the closure of the duct by the thickened intima and a change in the direction of blood flow.

In children with developmental defects, the duct does not close in time, but continues to function. This disrupts pulmonary circulation and normal heart function. PDA is usually diagnosed in newborns and infants, somewhat less frequently in schoolchildren, and sometimes even in adults. The pathology is found in full-term children living in high mountain areas.

Etiology

The etiology of PDA is currently not fully understood. Experts highlight Several risk factors for this disease:

• Premature birth
• Low birth weight
• Vitamin deficiencies,
• Hereditary predisposition
• Marriages between relatives
• Mother's age is over 35 years,
• Genomic pathologies - Down, Marfan, Edwards syndromes,
• Infectious pathology in the 1st trimester of pregnancy, congenital rubella syndrome,
• Drinking alcohol and drugs during pregnancy, smoking,
• Irradiation with X-rays and gamma rays,
• Taking medications during pregnancy,
• Impact chemical substances on the pregnant woman's body,
• Systemic and metabolic diseases of the pregnant woman,
• Intrauterine endocarditis of rheumatic origin,
• Maternal endocrinopathies – diabetes mellitus, hypothyroidism and others.

The causes of PDA are usually combined into 2 large groups– internal and external. Internal reasons associated with hereditary predisposition and hormonal changes. TO external reasons include: poor ecology, industrial hazards, diseases and bad habits mothers, toxic effect on the fetus various substances– drugs, chemicals, alcohol, tobacco.

PDA is most often detected in premature infants. Moreover, than less weight newborn, the higher the likelihood of developing this pathology. Heart disease is usually combined with developmental anomalies of the digestive, urinary and reproductive systems. Immediate reasons non-occlusion of the ductus Botallova in in this case are respiratory disorders, fetal asphyxia, long-term oxygen therapy and parenteral fluid therapy.

Video: medical animation about the anatomy of the ductus arteriosus

Symptoms

The disease can be asymptomatic or extremely severe. With a small diameter of the duct, hemodynamic disturbances do not develop, and pathology for a long time not diagnosed. If the diameter of the duct and the volume of the shunt are significant, the symptoms of the pathology are pronounced and appear very early.

Clinical signs:

Children with PDA often suffer from bronchopulmonary pathology. Newborns with a wide ductus arteriosus and a significant shunt volume are difficult to feed, they do not gain weight well and even lose weight.

If the pathology was not detected in the first year of life, then as the child grows and develops, the course of the disease worsens and manifests itself more clearly clinical symptoms: asthenia of the body, tachypnea, cough, frequent inflammatory diseases of the bronchi and lungs.

Complications

Severe complications and dangerous consequences OAP:

• - infectious inflammation the inner lining of the heart, leading to dysfunction of the valve apparatus. Patients develop fever, chills and sweating. Signs of intoxication are combined with headache and lethargy. Hepatosplenomegaly develops, hemorrhages appear in the fundus and small painful nodules on the palms. Treatment of pathology is antibacterial. Patients are prescribed antibiotics from the group of cephalosporins, macrolides, fluoroquinolones, and aminoglycosides.
• develops in the absence of timely cardiac surgery and consists of insufficient blood supply internal organs. The heart stops pumping blood in full, which leads to chronic hypoxia and deterioration in the functioning of the entire body. Patients experience shortness of breath, tachycardia, swelling of the lower extremities, fast fatiguability, sleep disturbance, constant dry cough. Treatment of pathology includes diet therapy, drug therapy aimed at normalizing blood pressure, stabilization of heart function and improvement of blood supply.
• - acute illness, caused by the appearance of foci of ischemic necrosis in the heart muscle. The pathology manifests itself as characteristic pain, which is not relieved by taking nitrates, agitation and anxiety of the patient, pale skin, and sweating. Treatment is carried out in a hospital setting. Patients are prescribed thrombolytics, narcotic analgesics, nitrates.
• Reverse blood flow through the wide ductus arteriosus can lead to and.
• Pulmonary edema develops when fluid moves from the pulmonary capillaries into the interstitial space.

Rarer complications of PDA include: aortic rupture, incompatible with life; and rupture of the ductus arteriosus; sclerotic nature; cardiac arrest in the absence of corrective therapy; frequent acute respiratory infections and acute respiratory viral infections.

Diagnostics

Diagnosis of PDA is carried out by doctors of various medical specialties:

1. Obstetricians and gynecologists monitor the development of cardio-vascular system fruit,
2. Neonatologists examine the newborn and listen,
3. Pediatricians examine older children: they perform heart auscultation and, if pathological murmurs are detected, refer the child to a cardiologist,
4. Cardiologists make a final diagnosis and prescribe treatment.

Are common diagnostic measures include a visual examination of the patient, and percussion of the chest, auscultation, instrumental research methods: electrocardiography, radiography, ultrasound of the heart and large vessels, .

During the examination, deformation of the chest, pulsation of the heart area, and a shift of the heart impulse to the left are revealed. By palpation, systolic tremors are detected, and by percussion, an expansion of the boundaries of cardiac dullness is detected. Auscultation is the most important method in the diagnosis of PDA. Its classic sign is a rough, continuous "machine" noise caused by the unidirectional movement of blood. Gradually it disappears, and an accent of 2 tones appears above pulmonary artery. IN severe cases Multiple clicks and rumbling noises occur.

Instrumental diagnostic methods:

• Electrocardiography does not reveal pathological symptoms, but only signs.
• X-ray signs pathologies are: reticular pattern of the lungs, expansion of the shadow of the heart, bulging of a segment of the pulmonary artery trunk, flocculent infiltrate.
• Ultrasound of the heart allows you to visually evaluate the work of different parts of the heart and valve apparatus, determine the thickness of the myocardium, the size of the duct. Doppler ultrasound allows you to most accurately establish the diagnosis of a PDA, determine its width and regurgitation of blood from the aorta to the pulmonary artery. Ultrasound examination of the heart allows you to detect anatomical defects of the heart valves, determine the location of the great vessels, and evaluate contractility myocardium.
• Phonocardiography- a simple method that allows you to diagnose heart defects and defects between cavities by graphically recording heart sounds and noises. Using phonocardiography, you can objectively document the data obtained while listening to the patient, measure the duration of sounds and the intervals between them.
• Aortography- informative diagnostic method, which consists in supplying a contrast liquid into the heart cavity and taking a series of x-rays. Simultaneous staining of the aorta and pulmonary artery indicates patent ductus Botallus. The resulting images remain in the computer's electronic memory, allowing you to work with them repeatedly.
• Catheterization and cardiac catheterization in case of PDA, it allows an absolutely accurate diagnosis if the probe passes freely from the pulmonary artery through the duct into the descending aorta.

Probing of the cardiac cavities and angiocardiography are necessary for more accurate anatomical and hemodynamic diagnostics.

Treatment

The earlier the disease is detected, the easier it is to get rid of it. When the first signs of pathology appear, you should consult a doctor. Early diagnosis and timely therapy will increase the patient’s chances of a full recovery.

If the child loses weight, refuses active games, turns blue when screaming, becomes drowsy, experiences shortness of breath, cough and cyanosis, is often exposed to ARVI and bronchitis, should be shown to a specialist as soon as possible.

Conservative treatment

Drug therapy is indicated for patients with mild clinical signs and the absence of complications. Drug treatment of PDA is carried out in premature infants and children under one year of age. If after 3 courses of conservative therapy the duct does not close, and the symptoms of heart failure increase, proceed to surgical intervention.

1. A sick child is prescribed special diet limiting fluid intake.
2. Respiratory support is necessary for all premature infants with PDA.
3. Patients are prescribed prostaglandin inhibitors, which activate independent obliteration of the duct. Typically, intravenous or enteral administration of Indomethacin or Ibuprofen is used.
4. Antibiotic therapy is carried out to prevent infectious complications– bacterial endocarditis and pneumonia.
5. Diuretics – “Veroshpiron”, “Lasix”, cardiac glycosides – “Strofanthin”, “Korglikon”, ACE inhibitors– “Enalapril”, “Captopril” are prescribed to persons with clinical signs of heart failure

Cardiac catheterization

cardiac catheterization

Cardiac catheterization is prescribed for children who conservative therapy did not give the expected result. Cardiac catheterization is a highly effective method of treating PDA with a low risk of complications. The procedure is performed by specially trained pediatric cardiologists. A few hours before catheterization, the child should not be fed or watered. Immediately before the procedure, he is given cleansing enema and a sedative injection. After the child relaxes and falls asleep, manipulation begins. The catheter is inserted into the chambers of the heart through one of the large blood vessels. There is no need to make incisions in the skin. The doctor monitors the progress of the catheter by looking at the monitor screen of a special X-ray machine. By examining blood samples and measuring blood pressure in the heart, he obtains information about the defect. The more experienced and qualified the cardiologist, the more effective and successful the cardiac catheterization will be.

Cardiac catheterization and duct clipping during thoracoscopy - an alternative surgical treatment vice.

Surgical treatment

Surgical intervention allows you to completely eliminate PDA, reduce the patient’s suffering, and increase his resistance to physical activity and significantly prolong life. Surgical treatment consists of performing open and endovascular operations. The PDA is ligated with a double ligature, vascular clips are applied to it, transected and sutured.

Classic surgical intervention represents open surgery, which consists of ligating the Botallov duct. The operation is performed on a “dry” heart while the patient is connected to a ventilator and under general anesthesia.

Endoscopic method surgical intervention is minimally invasive and minimally traumatic. A small incision is made in the thigh through which a probe is inserted into the femoral artery. It is used to deliver an occluder or a spiral to the PDA, which closes the lumen. The entire progress of the operation is monitored by doctors on the monitor screen.

Video: surgery for PDA, anatomy of the Botallian duct

Prevention

Preventive measures consist of eliminating the main risk factors - stress, taking alcohol and medications, and contacts with infectious patients.

After surgical correction of the pathology, the child must engage in dosed physical exercise and massage at home.

Quitting smoking and screening for genetic abnormalities will help reduce the risk of developing congenital heart disease.

Prevention of congenital heart disease comes down to careful pregnancy planning and medical and genetic counseling for people at risk.

It is necessary to carefully monitor and examine women infected with the rubella virus or with concomitant pathology.

The child should be provided with proper care: enhanced nutrition, physical activity, physiological and emotional comfort.

The human blood supply system includes the main organ, the heart, and the arteries coming from it, which return from the tissues through veins. Its correct functioning is determined by normal anatomical structure and hemodynamic conditions. If one of these two conditions is violated, the blood supply to other organs is also damaged.

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 problems of the parents themselves. As pediatricians teach, you need to start preparing for the birth of a child from your childhood, thereby implying that both spouses must carefully take care of themselves when planning a family. So, long before pregnancy, it is worth giving up bad habits, curing chronic diseases, and the expectant mother should correct her vision, nutrition, and normalize rest. However, cases still occur when healthy family Children are born with congenital malformations. And therefore in different terms During gestation, a woman must undergo periodic ultrasonography, which allows us to identify fetal disorders in utero. But even the diagnosis of such a process does not mean the need to terminate the pregnancy, because medicine does not stand still, and currently most congenital defects are treated. One of these bright examples is the patent ductus arteriosus (Batalov).

Functions of the duct

The circulatory system of a fetus is significantly different from that of an adult. This is due to his special nutrition during intrauterine development - through the placenta, from the mother’s blood, all the substances he needs for growth, including oxygen, enter his own blood. Therefore, the need for the respiratory and digestive system for the period before birth is simply absent, while the cardiovascular system works in enhanced mode. One of the most important features hers are oval window V interatrial septum and Batalov duct. With the help of the latter, the aorta is connected to the trunk of the pulmonary artery, and thus the mother’s blood, bypassing the pulmonary vessels, enters the systemic circulation of the fetus. Normally, in the first hours of a baby’s life, when his lungs expand and he begins to breathe on his own, he should stenose, and during the first days - completely obliterate and turn into a ligament. However, if this does not happen, and the Batal duct remains open, then severe hemodynamic disturbances occur in the child’s blood supply system.

Video on the topic

Etiology

There are three main reasons for this malformation. The first is the other congenital pathology, with which the open duct of Batal is combined, for example Down syndrome or tetralogy of Fallot. Second - severe course childbirth with complications leading to hypoxia or asphyxia of the fetus. This may be their slowness, prolonged standing of the head above the entrance to the pelvis, premature rupture of amniotic fluid, the occurrence of an ascending infection, entanglement of the neck with the umbilical cord or closure respiratory tract membranes and many others. And finally, the third is initially, i.e. in utero, an abnormally wide or long duct of Batal is formed due to the influence of factors from the mother on the child during the period of heart formation, that is, in the first 10 weeks of pregnancy. Thus, many have teratogenic properties medications, especially hormonal drugs, sleeping pills and antibiotics, viruses, alcohol, smoking, stressful situations. But until this time, a woman should be surrounded by exceptional care and be in a state of physical and psycho-emotional peace.

Pathogenesis

Hemodynamic disturbances with this congenital defect heart failure, such as patent duct of Batal, is 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 gradually develops in it, followed by the exudation of the liquid part of the plasma into the surrounding tissues. The lungs become easily susceptible to infections and become unable to properly oxygenate the blood. At the same time, due to a decrease in the volume of circulating blood in big circle its depletion occurs, all organs suffer from severe hypoxia, and since the baby’s body grows with maximum intensity during the first year, they require extremely nutrients and energy. And due to a deficiency of this, their dystrophy increases, as a result of which their functioning suffers. The child slowly gains weight, often gets sick, becomes restless, and constantly screams.

Operation

However, the method of treating this pathology is not so complicated, because the only problem remains the open Batalov duct. Surgery becomes the only option for his treatment, because conservative methods do not work on him. Surgical correction of the defect is usually performed at 5-10 years of age, but best age for this it is considered 3-5 years. The main thing is that this happens before puberty, when the body’s hormonal levels begin to change and it will need more blood supply. There is evidence of isolated cases of treatment in adulthood after late diagnosis of the defect. During the operation, the Batal duct is simply sutured or ligated using transvascular access from the femoral artery to minimize trauma to the baby’s tissues. All this happens under the control of angiography and with the help of endoscopic devices. This mini-operation has already been actively developed by surgeons and is not complicated.

Forecast

After treatment, the disease has a favorable outcome, and life expectancy is usually not affected. This depends on the stage of compensation of the defect at the time of its detection and on the degree of changes in vascular system lungs. However, gradually such patients develop severe heart failure, often complicated infective endocarditis. Even isolated cases have been described in which unoperated patients lived to be 70-80 years old due to small deviations of the ductus arteriosus and the strong compensating ability of their body.

Patent ductus arteriosus in children is a pathological connection in the form of a small bloodstream that connects large vessels - the aorta and pulmonary artery. This duct is also called the Batalov duct. The baby needs it when he is still in the womb and the baby’s lungs are not functioning.

After birth, when newborns begin to breathe independently, blood is redistributed. The duct of Batalus closes a couple of days after birth. In premature babies, this period can last up to two months. This happens normally. PDA refers to cardiovascular pathology(heart disease).

Causes of the disease

There is no clear answer why this duct is open in a child after birth. According to statistics, this pathology occurs twice as often in newborn girls as in male infants. Today, prematurity is considered the main cause of PDA. Other reasons include the following:

• congenital heart defects of a different nature
• prematurity of infants
• baby's weight is less than 2.5 kg
• heredity
• fetal hypoxia
• genetic diseases
• presence of diabetes mellitus in the mother
• rubella suffered during pregnancy
• radiation or chemical exposure during pregnancy
• taking illegal drugs during pregnancy
• smoking or taking narcotic drugs during pregnancy.

Signs and symptoms

The signs of this pathology directly depend on the size (diameter) of the open duct. With a small (up to 4 mm) diameter of the duct, the work of the heart is not particularly affected; this pathology can occur without symptoms for a long time and remain undetected.

With a larger diameter of the Batalov duct, overload occurs in the pulmonary artery, which negatively affects the functioning of the heart, then this disease requires treatment. If this is not done, then in the future this defect will lead to faster wear and tear (aging) of the heart and a significant reduction in life.

You can suspect this pathology in a baby based on the following signs:

• slow weight gain
• pale skin
• feeding difficulties
• coughing
• hoarse voice
• frequent bronchitis and pneumonia
• poor mental and physical development
• lack of weight.

Diagnosis of the disease

To make a diagnosis, doctors use a stethoscope to listen to the newborn's heart. After two days, the heart murmurs should stop.

If this does not happen, then other diagnostic methods are used: x-ray, ultrasound of the heart, ECG. If necessary, doctors perform probing of the aorta and pulmonary artery.

• rapid breathing and lack of air even with minimal exertion
• cough
• cyanosis (blueness) of the lower extremities
• lack of weight
• fast fatiguability.

Treatment Options

Independent closure of the Batalov duct is possible only in children under 3 months of age. If this does not happen, then more late period is no longer possible.

Treatment of this pathology depends on age, the diameter of the open duct and the existing symptoms. The decision on how to treat, which type of treatment to use, is made by the doctor.

During treatment little patient prescribe a special diet. Medical nutrition includes limitation drinking regime. Limit the consumption of milk, juice, tea. This diet increases the effect of treatment. Eating a limited amount of fluid prevents swelling. The following types of treatment are used:

• medicinal (drugs)
• duct catheterization
• ligation of the pathological duct.

Modern medicine successfully treats other heart diseases using both conservative and operationally, for example, mitral valve prolapse.

Drug treatment

Before the age of one year, only drug treatment is carried out under medical supervision. The following drugs are used for this:

• nonsteroidal anti-inflammatory drugs, such as ibuprofen or indomethacin
• diuretics, for example Digoxin - it is prescribed to prevent the development of pulmonary edema
• antibiotics are prescribed if necessary to rule out possible bacterial endocarditis and pneumonia
• A treatment technique such as positive end expiratory pressure (PEEP) is used, which prevents blood stagnation in the lungs and reduces the risk of developing pulmonary edema, using a breathing apparatus and a mask.

If there are no other complications or defects, the child is prescribed only drug treatment.

In case of complications ( arterial hypertension etc.) apply surgical methods of treatment.

Catheterization of the ductus arteriosus

How to treat children after one year? If indicated, catheterization or surgery is possible.

Catheterization is considered the safest in terms of possible complications. This operation is performed only in a hospital. A tiny incision is made in the skin and the doctor uses a long catheter to insert the catheter through a large artery or vein. The procedure is performed only by experienced cardiologists.

Surgery

Surgical treatment consists of ligation of the ductus arteriosus. Optimal age for such an operation from 1 to 3 years. For newborn children, surgery is performed only for health reasons if the PDA has a large diameter.

Also surgically Coarctation of the aorta can also be treated.

Doctor advises

If there are no other defects, then the prognosis for recovery from PDA is positive and after successful treatment the child can lead the same active lifestyle as his healthy peers: play sports, dance, etc. The treatment method will be suggested by the cardiologist depending on the size of the PDA. A patent ductus arteriosus in children is not a death sentence—it can be successfully treated.

Video for the article

The ductus arteriosus or Botallus is a specific channel that communicates the pulmonary artery and the aorta. It exists in newborn babies and closes during the first three weeks of the baby’s life. If the patent ductus arteriosus does not close and the blood continues to mix, then it is customary to talk about congenital heart disease with the formation of a patent Botallian canal.

Patent ductus arteriosus: normal or pathological?

The ductus arteriosus is normally open only in babies who are in the womb and do not need pulmonary circulation, so they receive oxygen by direct entry from the mother’s body through the umbilical cord and pulmonary artery into the aorta. Normally, this formation begins to close after the first breath and completely ceases to function by the third month of life from birth. PDA in children under three months of age is considered to be a physiological norm.

The picture shows healthy heart(left) and heart defect PDA (right)

Patent ductus arteriosus in infants over 3 months and adults is a heart defect, which is accompanied by disturbances in its functioning and provokes the development of numerous complications from other organs.

If in childhood developmental defect is practically asymptomatic, then as the child’s body grows up, it begins to appear warning signs cardiovascular disorders, respiratory failure, delays in physical and mental development, as well as life-threatening complications of the pathological condition.

Why is a patent ductus arteriosus dangerous? If the disease is not diagnosed in time, then the child without adequate treatment is exposed to enormous risks of developing life-threatening complications. For example, when the ductus Botall is open, septic endocarditis may occur with damage to the valvular apparatus of the heart and disruption of its functionality.

With age, a patent canal can cause symptoms of acute and chronic heart failure, thromboembolism, as well as conditions that require emergency care and have a high mortality rate.

Why doesn't the OAP close?

Unfortunately, the exact reasons why the ductus arteriosus does not close in newborns are not yet known to science. Scientists put forward a variety of theories about the development of this defect. At the moment, we have been able to identify several decisive factors that take part in the formation of the defect:

• genetic pathologies on the part of the child, chromosomal mutations, including Down syndrome and the like;
• premature birth before 37 weeks;
• low baby weight at birth;
• congenital viral diseases (most often a patent aortic opening is combined with congenital rubella);
• asphyxia in a newborn in the first minutes after birth;
• intrauterine growth retardation;
• bad habits of the mother: smoking and drinking alcohol during pregnancy.

How does the disease manifest? Features of the clinical picture of the disease relative to the age of the patients

As is known, the symptoms of the disease and the nature of the pathological manifestations directly depend on the diameter of the patent ductus arteriosus. The wider the hole, the more severe the disease will be and the sooner the first signs of pathology in the cardiovascular system will appear.

According to medical literature, non-closure of the Botallov duct in children in the first months of life does not have a characteristic clinical picture. This asymptomatic The disease can last about three months, after which the duct either closes on its own or manifests itself in the form of certain disturbances in the functioning of the heart.

In a child of the first year of life, the disease clinic identifies the following main symptoms:

• poor weight gain;
• problems during feeding;
• respiratory disorders;
• increased sweating.

Complex forms of the disease, when the congenital defect behaves very aggressively and the canal width is more than 5 mm, are manifested by a symptom complex, the main signs of which may require emergency care.

A baby with a severe version of the disease behaves restlessly, gains weight poorly, and gets sick often infectious diseases respiratory tract. Such kids have hoarse voice, cough while crying, lag behind in physical and mental development.

Even if all of the above signs are present, it can be difficult for a doctor to suspect a diagnosis of PDA, since similar symptoms are also characteristic of other diseases of internal organs. The presence of an open duct can be definitively determined only with the help of additional instrumental methods research.

Patent ductus arteriosus in children over one year of age has the same symptoms as this disease in adults. Such patients complain of shortness of breath, cough, frequent bronchitis, as well as blue discoloration of the lower extremities and fatigue.

The question of whether the ductus botallus can close on its own without drug or surgical correction worries many. Doctors warn that the functioning canal between the aorta and the pulmonary artery usually closes spontaneously between birth and the first 3 months. If this does not happen, you should not hope for self-healing.

Modern diagnostics

A doctor can suspect a PDA in children by the presence of a pathological diastolic systolic murmur in the heart during an auscultatory examination of the organ. Similar sound disturbances occur with various malformations of the cardiovascular system and require additional diagnostics. In order to detect the unclosed Batalov duct, specialists today use the following instrumental techniques:

1. Ultrasound or echocardiomonitoring of the heart allows you to determine the presence of a particular congenital heart disease, as well as estimate its size, characteristics and diagnose possible thickening of the walls of the heart chambers
2. An electrocardiographic study, as a rule, does not have much informative value in the process of diagnosing a patent arterial canal, but it can be used to establish the presence of hypertrophy of the left heart.
3. Transvascular cardiac catheterization makes it possible to determine cardiac malformations and accurately determine the location, size and characteristics of these defects.
4. Chest X-ray is an outdated method for determining heart defects, which is practically not used today due to its low information content and the harmful effect it has x-ray radiation on a growing organism.

The video shows good visibility of the flow from the aorta into the pulmonary artery system (red flow)

How is patent ductus arteriosus treated?

Modern treatment of the disease in practice is implemented through the use of medications, cardiac catheterization techniques and surgical correction of the defect. The choice of therapeutic tactics depends on several factors, among which the size of the open canal plays a decisive role, clinical manifestations illness and the likelihood of developing severe complications.

1. Non-surgical treatment

In most cases, in children of the first year of life, patent ductus arteriosus is treated conservative method. Indications for treatment without surgery are the following conditions:

• the presence of an open ductus arteriosus from 2 mm to 5 mm in diameter;
• absence of concomitant heart defects and defects;
• absence of complications that prevent the heart from functioning normally;
• asymptomatic course of the disease or poor clinical picture.

During the implementation of therapy painful condition apply the following groups medicines:

• antibacterial agents that help prevent the development of complications from the heart and lungs in the form of bronchitis, pneumonia, myocarditis, endocarditis, and the like;
• non-steroidal anti-inflammatory dosage forms which help the ductus arteriosus close and prevent the formation of blood clots in the heart (NSAIDs are recommended to be used for some time after the closure of the PDA);
• symptomatic treatment of manifestations of pulmonary and heart failure, vitamin therapy, immunomodulators.

With a competent approach to conservative treatment, within several months from the start of therapy, the patent canal between the aorta and the pulmonary artery is able to close on its own, without leaving pathological symptoms. Naturally, if the AOP is closed, which is confirmed by ultrasound data, drug treatment of the disease is stopped and the diagnosis of heart disease is removed from the patient.

1. Cardiac catheterization

Cardiac catheterization is indicated when the normal process of closing the channel is not possible without external assistance, without compromising the integrity of the chest. The method has high efficiency and has minimal risks development of complications. The procedure is performed for children over 12 months and adults.

1. Surgical treatment

In severe cases, when a patent ductus arteriosus threatens the normal functioning of the child and is complicated by serious illnesses, patients are advised to surgical correction with ligation of the unclosed canal.

Currently, operations that make it possible to endovascularly close the hole between the aorta and the pulmonary artery are widely used throughout the world and are even applied to premature newborns. The result of such manipulation is usually positive, and the prognosis for the life of young patients is favorable.