Andersons pediatric cardiology 1075
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ArterialDuct
ItsPersistenceandItsPatency
Lee.N.Benson,DianeE.Spicer,RobertH.Anderson
Abstract
Thearterialductisafetalbloodvesselthatisprogrammedtocloseshortly
afterbirth.Ifthevesselremainspatentbeyond3monthsoflife(a
persistentlypatentarterialduct)itcanresultinvolumeloadingoftheleft
heartandshouldbeclosedeithersurgicallyorbyacatheter-based
procedure.Apatentarterialductiscommoninthenewborn,particularly
prematureinfants,andcancontributetopersistentrespiratoryproblems.
Earlysymptomsareuncommonbutmayincludedyspneaandfailureto
thriveinthemostextremecases.Anuncorrectedpatentductmayleadto
congestiveheartfailurewithincreasingage.Insomecongenitalheart
lesions(e.g.,atrioventricularconcordance,ventriculoatrialdiscordance)a
patentductistheonlypathwaywhereoxygenatedbloodcanmixwith
deoxygenatedblood.Insuchcases,prostaglandinsareinfusedtokeepthe
ductopen.Nonsteroidalantiinflammatorydrugscanbeusedtoclosethe
ductintheprematureinfantbutshouldnotbeadministeredtothosewith
congenitalheartdisease,inwhomtheductisusedtoaugmentpulmonary
bloodflowormaintainsystemicflowinleftheartobstructivelesions.This
chapterdetailswhatcontrolsductalpatency,itspathophysiology,andits
effectonthecirculationinheathanddisease.
Keywords
Patentarterialduct;patentductusarteriosus;prostaglandins;ductal
stent;indomethacin;Amplatzerductoccluder;hybridprocedure
Allthesearrangementsaremarvelous,withoutanyquestion.Butwe
havetoconsiderthatitexceedsallexpectationshowsoontheocclusion
ofalltheseopeningstakesplace.
R.E.SIEGAL
