Persistent ductus arteriosus
| Classification according to ICD-10 | |
|---|---|
| Q25.0 | Persistent ductus arteriosus Botalli |
| ICD-10 online (WHO version 2019) | |
A persistent ductus arteriosus botalli ( ductus arteriosus persistens , persistent ductus arteriosus , PDA ) is present if the ductus arteriosus , which connects the aorta (the main artery ) and the pulmonary trunk (pulmonary artery) in the fetal (prenatal) bloodstream , establishes itself for three months has not closed after birth. It usually closes in the first few days of life. The persistent ductus arteriosus is one of the congenital heart defects.
Symptoms
A small PDA does not cause any symptoms and is only noticed by a noise ( machine noise ) during the preventive check-ups . A larger PDA means a left-right shunt , in which blood from the arterial body circulation goes directly back into the pulmonary circulation. This can lead to signs of heart failure and an increased susceptibility to infections in children, sometimes also referred to as diastolic aortic tap syndrome. Since a larger PDA also carries a higher risk of endocarditis , a larger PDA is usually closed. In connection with various complex congenital heart defects , however, a ductus arteriosus is artificially kept open by the administration of prostaglandins in order to ensure the survival of the children.
During auscultation , when the ductus arteriosus is open, the loudest “continuous sound” heard above the second intercostal space to the left of the sternum is typical; on palpation a buzzing felt over the base of the heart.
therapy
Medicinal
If the natural closure is delayed, it can be supported by drugs that inhibit prostaglandin synthesis, so that in many cases a normal circulatory situation is achieved after the birth. Approved for this indication is z. B. the active ingredient ibuprofen . Indomethacin is also used in off-label use .
In animals, drug treatment is usually not possible because the defect is discovered very late on the one hand and, on the other hand, there is often a different form of malformation than in humans, i.e. the PDA does not or no longer reacts to the drug.
Operational
If the closure cannot be achieved conventionally, an invasive, surgical measure is necessary. From 1938 ( Robert Edward Gross and JP Hubbard) to 2005 this was done with the help of a surgical procedure. The incision was made on the left side of the chest between the ribs, the PDA was tied off by one or two ribbons, depending on its shape and length, and was often cut through between these constrictions.
Today, the PDA in larger infants is usually closed with a cardiac catheter with one or more coils or an umbrella system. Various makes are available for this, which are selected depending on the shape and length of the PDA. A large PDA in very young infants continues to be surgically sealed. After a PDA has been closed (if it is the only malformation) the child is completely healthy. Endocarditis prophylaxis is no longer required, and long-term check-ups are no longer expected.
For dogs and cats, in some centers it is possible to close the PDA in the same way using a cardiac catheter. Otherwise, it can also be closed during a chest operation.
literature
- Douglas J. Schneider and John W. Moore: Patent Ductus Arteriosus . In: Circulation . tape 114 , no. 17 , 2006, p. 1873-1882 , doi : 10.1161 / CIRCULATIONAHA.105.592063 , PMID 17060397 .
- Guideline: Persistent ductus arteriosus ( PdF , as of April 30, 2015)
Individual evidence
- ^ Klaus Holldack, Klaus Gahl: Auscultation and percussion. Inspection and palpation. Thieme, Stuttgart 1955; 10th, revised edition, ibid 1986, ISBN 3-13-352410-0 , pp. 181-184 and 196 f.
- ↑ Guidelines Society for Neonatology and Pediatric Intensive Care Medicine (PDF) , accessed on July 21, 2012.
- ^ Susanne Hahn: Children's cardiology. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. Walter de Gruyter, Berlin and New York 2005, ISBN 3-11-015714-4 , pp. 749 f .; here: p. 749.
