1, congenital ductus arteriosus is one of the common congenital heart disease, its incidence accounts for 10%-21% of congenital heart disease, the incidence of premature infants increased significantly, the incidence of birth weight less than 1 kg can be as high as 80%. It is more common in females, with a male to female ratio of about 1:3. It is more common in plateau areas, such as Qinghai and Tibet, where the incidence is much higher than that in plain areas, which is related to high altitude and low oxygen partial pressure.
2, the formation of the ductus arteriosus is a blood vessel connecting the descending aorta and pulmonary artery, is an important channel of blood circulation during the fetal period, after birth, with the emergence of respiration, lung pressure decreases, the partial pressure of oxygen increases, the increase of vasoactive substances, prompting the endothelium of the ductus arteriosus to proliferate and gradually fibrosis to complete the closure of the ductus arteriosus. Functional closure of the ductus arteriosus occurs 10-15 hours after birth, and 80% of the ductus arteriosus is completely closed in 3 months after birth.
3, the pathological changes of arteriovenous catheter failure usually, the human aortic pressure is much higher than the pulmonary artery pressure, normal adult aortic systolic pressure is about 140mmHg, pulmonary artery systolic pressure is about 30mmHg. due to the existence of pressure difference, the blood flowing through the aorta will partially shunt to the pulmonary artery, so that the blood flow in the lungs will be significantly increased, that is, too much blood in the lungs, similar to “flooding”. As the child grows older and longer, children with unclosed arterial ducts will gradually develop serious complications: pulmonary hypertension and heart enlargement. The physical and mental health of the child is seriously endangered.
4.What are the manifestations of children with unclosed ductus arteriosus?
(1) A small arterial duct, with a lumen diameter of 3mm or less and low blood flow to the lungs, is a mild case and mostly asymptomatic.
(2) Moderate ductus arteriosus, the lumen diameter is mostly between 3-6 mm, the blood flow to the lungs belongs to the medium level, usually manifests as palpitations, shortness of breath, weakness after activities, frequent respiratory infections, and mild growth disorders.
(3) Coarse ductus arteriosus, with a lumen diameter greater than 6mm (greater than 8mm in adults), has a large flow to the lungs, and the lungs are overly congested and prone to various complications prematurely. In infancy, feeding difficulties and weight gain can occur; recurrent respiratory infections, pneumonia and heart failure can be easily complicated, and treatment is difficult; growth and development can be significantly delayed; bruising of the lower extremities can occur in the late stage.
5.What other tests are needed to confirm the diagnosis of ductus arteriosus?
If you suspect that your child has ductus arteriosus, you need to go to a cardiologist. An experienced cardiologist can initially determine whether a child has an unclosed ductus arteriosus by auscultating the heart with a specific heart murmur. The diagnosis is then further clarified by cardiac ultrasound, cardiac macrovascular CT, and cardiac MRI, and any of these three tests can clarify the presence of an unclosed ductus arteriosus. We usually do only one cardiac ultrasound in the outpatient clinic to make a clear diagnosis.
6.What are the current domestic and foreign methods of treatment for patent ductus arteriosus?
Currently, there are two surgical methods for the treatment of patent ductus arteriosus in China.
(1) Traditional open-heart ligation surgery.
(2) Minimally invasive interventional surgery. Most of the cardiac centers in China prefer minimally invasive interventional treatment, and close to 95% of the cases in our hospital are treated with minimally invasive interventional treatment.
7.How is minimally invasive interventional treatment of arterial catheter implemented?
In layman’s terms, minimally invasive interventional therapy means that it can cure unclosed arterial ducts without surgery. It is currently the most advanced treatment method and is epoch-making in the treatment of unclosed arterial ducts.
This minimally invasive interventional technique has been researched and implemented internationally since the 1960s and applied clinically. Due to the limitations of the blocking device material, it was not popularized until the 1990s when an American company (AGA) produced a blocking device that fused perfectly with the human body tissue, and then it was popularized worldwide. Our hospital has been carrying out such procedures since 2004, and has so far completed more than 1000 cases of minimally invasive interventional procedures for patent ductus arteriosus, which is quite mature in terms of technology.
8.What is the best time for interventional treatment of patent ductus arteriosus?
The best time for interventional surgery for congenital patent ductus arteriosus: the traditional view is 3-5 years old. However, with the advancement of medical technology and the improvement of cardiac catheterization technology, and since the earlier the treatment of patent ductus arteriosus, the better it is for the growth and development of the child, the age of surgery is gradually becoming younger. In special cases, especially in children with coarse ductus arteriosus, pneumonia may persist and recalcitrant heart failure may occur, in which case early surgery is required.
9.What are the advantages of minimally invasive intervention compared with traditional open-heart surgery?
(1) No incision, no surgical scar, in line with modern minimally invasive and aesthetic requirements, avoiding the psychological pressure caused by surgical scar during the growth of the child.
(2) Less anesthesia risk, older children and adults do not need general anesthesia, and the anesthesia time for children who need anesthesia is shorter and the depth of anesthesia is shallow, so the risk is naturally reduced.
(3) No extracorporeal circulation and no blood transfusion are required, which significantly reduces the risk of surgery.
(4) The recovery is fast, and the child can get out of bed within 20 hours after the operation, and the hospital stay is short.
10.What are the precautions after the intervention?
(1) Appropriate restriction of activities within 6 months after the operation to avoid local impact in the heart area.
(2) Regular review: review cardiac ultrasound, electrocardiogram and cardiac film in 1, 3 and 6 months after the operation, and dynamically observe whether there is any change in the size of the heart and the position of the blocker after the operation.
11.What are the characteristics of middle-aged and old-aged arterial catheter failure?
In clinical work, we often encounter some middle-aged and elderly patients, whose (their) arterial ducts have the following characteristics: significant calcification of the arterial duct wall and reduced elasticity, often combined with pulmonary hypertension, hypertension and coronary artery disease, which increases the risk of interventional treatment and makes the procedure more difficult. Doing interventional procedures for middle-aged and elderly arterial catheter failure requires experienced surgeons and careful selection of blockers. Postoperatively, attention should be paid to taking appropriate anticoagulant drugs.
12.Treatment of complicated severe pulmonary hypertension?
Some patients have developed severe pulmonary hypertension due to the lack of early treatment. Most of them have developed cyanosis, lower limb edema and cardiac insufficiency, and most of them have lost the opportunity of surgery and can only rely on medications to relieve the symptoms. Currently, the following two drugs are recommended: bosentan and sildenafil.
13.What are the main points of care for children with unclosed ductus arteriosus in normal life?
Patients with patent ductus arteriosus are physically weak, so they should pay attention to rest, avoid intense exercise, don’t watch too much TV and play, and get enough sleep. When patients go out, it is best to be accompanied by family and friends so that outsiders don’t understand the patient’s medical history and handle the situation blindly. To keep the air fresh, open the window for half an hour every morning, and pay attention to keeping warm when opening the window. If there is no condition to take a bath, you can use wet water scrubbing to keep the skin clean. It is not advisable to go to public places to prevent infection diseases.
14.What are the dietary considerations for children with unclosed ductus arteriosus?
Pay attention to dietary hygiene: Patients with unclosed ductus arteriosus should pay attention to supplemental nutrition, generally nothing special is contraindicated, but should consume food with high nutritional value and easy to digest, such as lean meat, fish, eggs, fruits and various vegetables. General patients do not need to limit the amount of salt, patients with cardiac insufficiency should strictly control salt intake (4-8 grams per day for adults, 2-4 grams for children) and give easy-to-digest soft food, such as mixed ravioli, noodles, thin rice, etc. In addition, patients should eat less and more meals, not too much food, not to mention overeating, so as not to increase the burden on the heart. The diet should be fresh and hygienic to prevent diarrhea from aggravating the disease. Children should control snacks and drinks, do not eat snacks that are not clean, expired or contain more coloring and additives.
15.How can patients with unclosed arterial catheters perform moderate activities after surgery?
Pay attention to appropriate activities: For patients with smooth surgery and fast recovery after surgery, activities are generally appropriately limited after discharge. For those with cardiac function in class I or II, they can do some physical activities in their daily life as they can according to the situation, and the amount of activities should not cause fatigue. The range of activities should be indoor first and then outdoor. Most of the patients can go to school or work after discharge if there is no change in their condition, and gradually transition from light work to normal work. If you feel fatigue or shortness of breath, you should stop working and continue to rest. In patients with preoperative cardiac function above class III, severely enlarged heart and severe pulmonary hypertension, it takes a longer time for the heart to return to normal or basic normal.