Patent ductus arteriosus is one of the common types of congenital heart disease in children, accounting for about 15% of the total number of
Patent ductus arteriosus is one of the common types of congenital heart disease in children, accounting for about 15% of the total number of congenital heart disease. Passive opening of fetal ductus arteriosus is an important channel of blood circulation.
Patent ductus arteriosus is common in premature infants, the incidence of 28 weeks before the birth of the baby can be accounted for in the incidence of about 80%, born about 15 hours after the functional closure, one year after birth should be completely closed in anatomy. If we continue to open, and produce pathophysiological changes, that is, patent ductus arteriosus
The main causes of patent ductus arteriosus can be divided into two categories: heredity and environment. Any factors that affect the development of cardiac embryo during fetal period may cause cardiac malformation. Simple genetic factors (such as gene mutation, chromosome aberration) accounted for 8%, accounted for only 2% of environmental factors, genetic and environmental interactions caused by accounting for the proportion of 90%. The environmental factors include pregnant mothers in the first 3 months of cold, rubella virus and Coxsackie virus infection; diabetes; lithium uptake; alcohol; maternal exposure to radiation; amphetamine drug taking in the early stages of pregnancy have been pregnant; early pregnancy, threatened abortion by some drugs such as miscarriage progesterone.
There are a lot of left to right heart anomalies at the left edge of the sternum, which can be heard by the same continuous machine like murmur or close to the double phase cardiac murmur. In order to establish the diagnosis of patent ductus arteriosus must be identified before treatment, the main malformations are discussed according to the order of the following.
(1) high ventricular septal defect with aortic valve prolapse
When the high ventricular septal defect is often associated with aortic valve prolapse deformity, resulting in aortic valve insufficiency, and cause the corresponding signs. Clinic at the left sternal border to hear two phase noise, diastolic not up for pouring the water conduction, but sometimes with continuous murmur is similar, it is difficult to distinguish. At present, color echocardiography has been used for routine examination of heart disease. In this disease, aortic valve prolapse can be shown to be abnormal and aortic blood flow is reversed into the left ventricle. In order to further clarify the diagnosis of retrograde ascending aortic and left ventricular angiography, the former can be shown in the ascending aorta contrast agent into the left ventricle, the left ventricular contrast agent through ventricular septal defect shunt human right ventricle and pulmonary artery. It is not difficult to make differential diagnosis.
(two) rupture of aortic sinus aneurysm
This disease is not rare in our country. The clinical manifestation and the ductus arteriosus is similar to that of the same nature can be heard continuous murmur, just a slightly different position and direction of conduction; rupture of right ventricle were partial to apical, broken conduction; right atrium conduction to the right. Such as color Doppler echocardiography showed aortic sinus malformation and the ventricular cavity and pulmonary artery shunt can be identified or real. Combined with retrograde ascending aortic angiography, the diagnosis can be established.
(three) coronary artery fistula
This coronary artery malformation is rare, can be heard with the patent ductus arteriosus with the same continuous murmur with tremor, but the site is low, and tend to the inside. Doppler color Doppler ultrasound can show the location of the fistula and its communication. Retrograde ascending aorta angiography can show the enlarged main branch of the coronary artery, or the branch and the fistula.
(four) aortic septal defect
Very rare. It is often associated with patent ductus arteriosus and has the same continuous murmur and peripheral vascular characteristics. A careful echocardiographic examination revealed that the shunt was at the root of the ascending aorta. Retrograde ascending aortic angiography.
(five) ectopic opening of coronary artery
The origin of the right coronary artery from the pulmonary artery is a rare congenital heart disease. The heart murmur is continuous, but lighter, and more superficial. Doppler ultrasonography is helpful in differential diagnosis. A retrograde ascending aortic angiography showed a continuous opening of the coronary artery with abnormal opening and direction as well as a tortuous collateral circulation.
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