Heart disease open ductus arteriosus

It is almost impossible to recognize a pathology in a baby up to one year old. Symptoms during this period do not appear, and it is impossible to identify a birth defect without a special examination. But in some cases, in infants with a birth defect, you can notice certain signs:

  • Slow weight gain or decrease.
  • The child has excessive sweating.
  • Breathing becomes quicker.
  • During feeding, difficulties may arise.

With a wide opening of the ductus arteriosus, the signs of pathology become more pronounced:

  • There is a cough;
  • During crying, the baby’s voice becomes hoarse;
  • The child often suffers from respiratory diseases;
  • Lag in physical and mental development from their peers.

If a congenital pathology has not been identified up to a year, then signs of an open arterial defect can be noticed later than this period. These include the following symptoms.

  • The occurrence of dyspnea after small physical exertion.
  • The baby has increased fatigue.
  • Frequent respiratory infections and coughing.
  • Due to a lack of oxygen in the blood, the skin of the legs turns blue.
  • Slow weight gain.
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Diagnosis of an open arterial duct in a child

  • You can diagnose a congenital pathology in a baby when making an anamnesis.
  • The doctor listens to the baby’s heartbeat, and the presence of extraneous noise may indicate a pathology.
  • In this case, additional examinations are prescribed.
  • With the help of heart ultrasound and dopplerography, you can accurately determine the diagnosis of congenital pathology.
  • Electrocardiography will not reveal pathology with a slight opening of the ductus arteriosus. In severe cases of the disease, it will help to notice changes.
  • X-ray examination determines the size of the heart and reveals blood flow disorders in the lungs.
  • Catheterization. This is a safe procedure, which is not only diagnostic, but also therapeutic. Using a thin needle, you can close the duct.
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The open Botallus duct accounts for 9,8% of all congenital heart defects. Its severity and forecasts strongly depend on the width of the shunt – the larger it is, the more difficult it is for the body to compensate for the pathology. As a result, arterial and venous blood flows mix, the heart and lungs experience severe overloads, pulmonary hypertension may develop, and after it – heart failure.

Children with OAP are characterized by slow growth and development, they are weak, often sick, they have poor appetite and fatigue. If the duct is wide enough, symptoms will appear in the first months, parents can notice such features:

  • Pallor (OAP refers to the so-called “white” heart diseases), which is gradually replaced by blueness of the skin.
  • Frequent breathing, shortness of breath after eating or crying.
  • Bad weight gain.
  • Lag in development.

If the duct is small, it may not appear during the first years. The presence of pathology can be suspected by the following general signs:

  • Fast fatiguability.
  • Soreness, frequent acute respiratory infections, bronchitis, pneumonia.
  • Tachycardia.
  • Increased sweating.

The open ductus arteriosus leads to progressive heart failure and over time, all children develop and progress its symptoms. In some cases, patients develop concomitant heart disease. So, for patients with OAP, the presence of bacterial endocarditis, an inflammation of the inner lining of the heart, is characteristic. Also, aneurysms can form in the Botallic duct, their rupture becomes the cause of death.

Diagnosis of heart disease in children

It is difficult to identify the open Botallov duct, when it is quite narrow, in the first years of the baby’s life. Most often, only a cardiologist can suspect a diagnosis after listening to the chest – with such a pathology, a constant systolic-diastolic murmur is clearly audible. If it is detected, the doctor will prescribe additional tests for the child:

  • ECG (visible overload of the left ventricle).
  • Echocardiography (using ultrasound, you can detect the shunt itself, determine its size and shape).
  • X-ray of the chest (structural changes in the myocardium – cardiomegaly, enlargement of the heart due to stretching of the left departments can be seen on it).
  • Phonocardiography (clearer listening to noise).
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Uncompensated heart disease can lead to chest deformity. In children, a noticeable change in skin color to white or cyanotic. If an open arterial duct is detected, it is very important to examine the child for other defects, as it is often accompanied by additional pathologies.

Treatment

What can you do

Self-treatment of a birth defect is unacceptable.

If pathology is suspected, parents should seek the help of a doctor.

When prescribing medication, parents must follow the doctor’s recommendations for the use of medicines.

During the treatment of pathology, the doctor may prescribe a diet. It is also necessary to reduce fluid intake for effective treatment.

What does the doctor do

How will the doctor treat the pathology? The method of treatment will depend on the age of the baby, signs of manifestation of the disease and the severity of the disease.

  • Until the child reaches the age of one year, he is prescribed treatment with drugs. This occurs in the case of mild symptoms and the absence of other heart defects.
  • To close the duct, the child must take anti-inflammatory non-steroid drugs.
  • Antibiotics can be prescribed to prevent complications.
  • Diuretics are used to detect heart failure.
  • To reduce congestion in the blood vessels of the lungs, a special method can be used. It is called the method of positive pressure at the end of exhalation.
  • If medications and other procedures have not yielded positive results, cardiac catheterization is performed. It is held for babies whose age has reached one year. Complications after catheterization are rare, and the result is positive.
  • The operation to close the ductus arteriosus is performed in babies of any age. Surgical intervention occurs in urgent cases when a pathology is detected in infants. If the diagnosis is made to a child older than one year, the operation is performed as planned.

Heart surgery and other methods

Conservative treatment of OAP is prescribed only for premature babies under the age of 1 month. During this period, the Botallov duct can still overgrow itself, so doctors use drugs that stimulate obliteration. In the event that after such therapy the child is still diagnosed with OAP, a heart operation is prescribed.

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There are several types of surgical procedures that eliminate this defect. All of them can be divided into open heart surgery and endovascular methods. The first involves opening the chest and ligation or clipping of the duct. But since they are associated with serious risks to the health of the child and require long-term postoperative rehabilitation, they are increasingly replaced with minimally invasive methods.

Endovascular surgery is much easier. The surgeon makes a puncture in a large artery, through which a catheter with a “plug” (an occluder or spiral) is inserted. A catheter is gradually inserted into the Botallov duct through the vessels, after which the “plug” remains in it, blocking the blood flow. A heart operation is performed under x-ray control – the doctor sees everything that happens on the screen. After the procedure, the patient remains in the hospital for another 1-3 days.

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Surgical treatments for OAP completely eliminate heart disease. And if the duct is blocked before structural changes have occurred in the myocardium or blood vessels, the human heart remains healthy.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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