Materiały źródłowe

• #1 Patent Ductus Arteriosus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK430758/

  The ductus arteriosus is a fetal vessel that allows the oxygenated blood from the placenta to bypass the fetal lungs in utero. […] The increased arterial oxygen tension and decrease in blood flow through the ductus arteriosus causes the ductus to constrict and functionally close by 12 to 24 hours of age in healthy, full-term newborns, with permanent (anatomic) closure occurring within 2 to 3 weeks. […] In premature infants, the ductus arteriosus does not close rapidly and may require pharmacologic or surgical closure to treat unwanted repercussions. […] During fetal life, the oxygen tension is low, and the pulmonary vascular system is not functioning. Coupled with circulating levels of prostaglandins from the placenta, this keeps the ductus patent. […] In most healthy newborns, the ductus will close within 12-24 hours of life. This occurs by contraction of the muscles of the ductus, which are sensitive to oxygen, acetylcholine, bradykinin, and endothelin.

• #2 Patent Ductus Arteriosus (PDA) – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/congenital-cardiovascular-anomalies/patent-ductus-arteriosus-pda

  Patent ductus arteriosus (PDA) is a persistence of the fetal connection (ductus arteriosus) between the aorta and pulmonary artery after birth. […] The ductus arteriosus is a normal connection between the pulmonary artery and aorta; it is necessary for proper fetal circulation. At birth, the rise in PaO2 and decline in prostaglandin concentration cause closure of the ductus arteriosus, typically beginning within the first 10 to 15 hours of life. If this normal process does not occur, the ductus arteriosus will remain patent. […] Physiologic consequences depend on ductal size. A small ductus rarely causes symptoms. A large ductus causes a large left-to-right shunt. If uncorrected, over time, a large shunt results in left heart enlargement, pulmonary artery hypertension, and elevated pulmonary vascular resistance, ultimately leading to Eisenmenger syndrome. […] Over time, a large shunt causes left heart enlargement, pulmonary artery hypertension, and elevated pulmonary vascular resistance, ultimately leading to Eisenmenger syndrome if untreated.

• #3 Patent Ductus Arteriosus (PDA): Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/891096-overview

  Patent ductus arteriosus (PDA), in which there is a persistent communication between the descending thoracic aorta and the pulmonary artery that results from failure of normal physiologic closure of the fetal ductus, is one of the more common congenital heart defects. […] The ductus arteriosus is normally patent during fetal life; it is an important structure in fetal development as it contributes to the flow of blood to the rest of the fetal organs and structure. From the 6th week of fetal life onwards, the ductus is responsible for most of the right ventricular outflow, and it contributes to 60% of the total cardiac output throughout the fetal life. Only about 5-10% of its outflow passes through the lungs. […] This patency is promoted by continual production of prostaglandin E2 (PGE2) by the ductus. Closure of the ductus before birth may lead to right heart failure. Prostaglandin antagonism, such as maternal use of nonsteroidal anti-inflammatory medications (NSAIDs), can cause fetal closure of the ductus arteriosus.

• #4 Patent Ductus Arteriosus (PDA): Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/891096-overview

  Furthermore, high reactivity to prostaglandin and reduced calcium sensitivity to oxygen in vascular smooth muscle cells contribute to contraction of the ductus. […] The absence of ductus arteriosus contraction in full-term neonates might be due to failed prostaglandin metabolism most likely caused by hypoxemia, asphyxia, or increased pulmonary blood flow, renal failure, and respiratory disorders. […] Cyclooxygenase (COX)-2 (an isoform of COX-producing prostaglandins) induction and expression might also prevent ductal closure. […] During late gestation, the decrease in prostaglandin levels results in constriction of the ductus arteriosus. Thus, the intimal cushions come into contact and occlude the ductus lumen. […] Further progression of disease is dependent on volume and pressure relationships. High volume yields increasing pulmonary artery pressures, eventually producing endothelial and muscular changes in the vessel wall. These changes may eventually lead to pulmonary vascular obstructive disease (PVOD), a condition of resistance to pulmonary blood flow that may be irreversible and will preclude definitive repair.

• #5 Patent ductus arteriosus (PDA) in preterm infants: Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/patent-ductus-arteriosus-pda-in-preterm-infants-clinical-features-and-diagnosis

  Patent ductus arteriosus (PDA) occurs commonly in preterm infants, especially in those with respiratory distress syndrome. […] The pathophysiology, clinical features, and diagnosis of PDA in preterm infants are reviewed here. […] After birth, the DA undergoes active constriction and eventual obliteration. […] A patent ductus arteriosus (PDA) occurs when the ductus fails to completely close after delivery. […] Key factors that maintain ductal patency in the fetus include:

• #6 Patent ductus arteriosus – Wikipedia

  https://en.wikipedia.org/wiki/Patent_ductus_arteriosus

  Patent ductus arteriosus (PDA) is a medical condition in which the ductus arteriosus fails to close after birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs from the aorta, which has a higher blood pressure, to the pulmonary artery, which has a lower blood pressure. […] The ductus arteriosus is a fetal blood vessel that normally closes soon after birth. This closure is caused by vessel constriction immediately after birth as circulation changes occur, followed by the occlusion of the vessels lumen in the following days. […] In a PDA, the vessel does not close, but remains patent (open), resulting in an abnormal transmission of blood from the aorta to the pulmonary artery. […] PDA is common in newborns with persistent respiratory problems such as hypoxia, and has a high occurrence in premature newborns. Premature newborns are more likely to be hypoxic and have PDA due to underdevelopment of the heart and lungs.

• #7 Patent Ductus Arteriosus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK430758/

  A patent ductus arteriosus (PDA) is rare in healthy term newborns. […] As gestational age decreases, the incidence of PDA increases. […] The patency of the ductus is promoted by prostaglandin E2. […] If the ductus remains patent after birth, it is associated with pulmonary edema and pulmonary hemorrhage, necrotizing enterocolitis, intraventricular hemorrhage, congestive heart failure, renal failure, and bronchopulmonary dysplasia (BPD). […] The magnitude of the left-to-right shunt depends on many factors, but the most important is the ratio of the pulmonary vascular resistance (PVR) to the systemic vascular resistance (SVR). […] If left untreated, pulmonary hypertension can develop, which will lead to premature death.

• #8 Patent Ductus Arteriosus (PDA): Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/891096-overview

  Thus, a PDA produces a left-to-right shunt. In other words, it allows blood to go from the systemic circulation to the pulmonary circulation. Therefore, pulmonary blood flow is excessive. […] The magnitude of the excess pulmonary blood flow depends on relatively few factors. The larger the internal diameter of the most narrow portion of the ductus arteriosus, the larger the left-to-right shunt. […] If the ductus arteriosus is restrictive, then the length of the narrowed area also affects the magnitude of the shunt. […] Finally, the magnitude of the left-to-right shunt is partially controlled by the relationship of the pulmonary vascular resistance (PVR) to the systemic vascular resistance (SVR). […] Failure of ductus arteriosus contraction in preterm neonates has been suggested to be due to poor prostaglandin metabolism because of immature lungs.

• #9 Patent ductus arteriosus in dogs: diagnosis and interventional occlusion – Veterinary Practice

  https://www.veterinary-practice.com/article/patent-ductus-arteriosus

  Patent ductus arteriosus (PDA) is a common form of congenital heart disease in dogs (Schrope, 2015; Oliveira et al., 2011). […] Failure to identify and close a PDA can result in premature death, with most affected dogs dying before one year of age (Eyster et al., 1976). […] In those surviving to adulthood, late PDA closure is still associated with a favourable outcome (Van Isral et al., 2003; Boutet et al., 2017). […] The ductus arteriosus (DA) forms part of the normal foetal circulation. It allows oxygenated maternal blood to bypass the non-functional foetal lungs. As oxygen tension increases at birth, smooth muscle in the DA should constrict, resulting in duct closure. In some dogs, however, there is a deficit in the amount of smooth muscle, which results in ineffective closure and retained patency (Buchanan, 2001).

• #10 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Patent-Ductus-Arteriosus-(PDA)-Overview.aspx

  Patent ductus arteriosus (PDA), one of the more common cardiac defects present at birth, is the persistence of an opening between the pulmonary artery and aorta. […] This opening is as a result of failure of the physiological fetus ductus arteriosus to close, which normally occurs soon after birth. […] The ductus arteriosus remains open during fetal development thanks to high levels of prostaglandins and low oxygen tension in the nonfunctional pulmonary system. […] Several studies have suggested that PDA occurs in premature babies due to the lungs being underdeveloped and poor metabolizers of prostaglandins. […] Other risk factors that may be associated with PDA is a positive family history of cardiac defects, and genetically linked conditions like Down syndrome. […] Maternal infection with German measles during pregnancy can cause damaging effects to the fetal heart and circulatory system and put the infant at greater risk of PDA. […] Studies have also shown that children born at higher altitudes have an increased susceptibility to PDA. […] Heart failure in PDA develops because of an excessive workload on the heart. […] PDA in premature infants may cause more serious consequences than in those born at full term.

• #11 Role of Extracellular Matrix in Pathophysiology of Patent Ductus Arteriosus: Emphasis on Vascular Remodeling

  https://www.mdpi.com/1422-0067/21/13/4761

  The intrinsic difference in ECM composition and the structuring of DA compared to that of Ao emphasize the critical role of ECM in the pathophysiology of PDA. […] The hypoxic zone induces local SMC death in the media and the production of growth factors that stimulate neointimal thickening, fibrosis, and permanent closure. […] The composition of ECM is critical in determining the success of endothelial detachment that permits SR thickening. […] The finding fails to explain the underlying mechanism for the determination of EC detachment that has been previously reported in a study to be related to an increase in HA. […] These findings suggest that the IEL can limit the passage of SMC from the media to the intima and its disruptions play a role in determining the fate of ductus closure.

• #12 Role of Extracellular Matrix in Pathophysiology of Patent Ductus Arteriosus: Emphasis on Vascular Remodeling

  https://www.mdpi.com/1422-0067/21/13/4761

  The ductus arteriosus (DA) is a shunt vessel between the aorta and the pulmonary artery during the fetal period that is essential for the normal development of the fetus. Complete closure usually occurs after birth but the vessel might remain open in certain infants, as patent ductus arteriosus (PDA), causing morbidity or mortality. […] Despite advances in the understanding of patent ductus arteriosus (PDA) molecular pathogenesis, pathways mediated by extracellular matrix (ECM) for the regulation of DA closure are not fully understood. Further knowledge of PDA pathogenesis is necessary to dissect the complex cell–matrix crosstalk regulating DA closure. […] The process is complex, with several mechanisms including intimal cushion formation, SMC migration and proliferation, endothelial cell proliferation, blood cell interaction, and ECM production. In this review, we will discuss the fundamental role of ECM in the pathogenesis of PDA.

• #13 Role of Extracellular Matrix in Pathophysiology of Patent Ductus Arteriosus: Emphasis on Vascular Remodeling

  https://www.mdpi.com/1422-0067/21/13/4761

  Together with reports on the persistence of the DA with elastic fiber abnormalities in the human PDA, these findings suggest that the IEL can limit the passage of SMC from the media to the intima and its disruptions play a role in determining the fate of ductus closure. […] The plasticity of the pulmonary circulation in the perinatal period also involves matrix regulation. Processes that prevent the regular decrease in pulmonary vascular resistance have been proposed to impair matrix regulation and cause aberrant developmental and structural changes in the PA.

• #14 Patent ductus arteriosus (PDA) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/patent-ductus-arteriosus/symptoms-causes/syc-20376145

  Patent ductus arteriosus is a persistent opening between the two main blood vessels leaving the heart. Those vessels are the aorta and the pulmonary artery. The condition is present at birth, which means it is a congenital heart defect. […] The constant opening causes too much blood to flow to the baby’s lungs and heart. Untreated, the blood pressure in the baby’s lungs might increase. The baby’s heart might grow larger and get weak. […] A large PDA causes irregular blood flow in the heart and lungs. As a result, pressure goes up in the pulmonary artery. Over time, the increased pressure damages the smaller blood vessels in the lungs. A life-threatening and lasting type of lung damage called Eisenmenger syndrome may occur.

• #15 Patent Ductus Arteriosus (PDA) | American Heart Association

  https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/patent-ductus-arteriosus-pda

  If the PDA is small, it won’t cause symptoms or problems because the blood flow and pressure in the heart and lungs aren’t changed appreciably from normal. […] If the PDA is large, breathlessness may be due to reduced heart function or problems related to high pressures in the lungs. High pressure may occur in the lung vessels because more blood than normal is being pumped there. Over time this may cause permanent damage to the lung blood vessels (pulmonary hypertension). […] Patients with a moderate- or large-sized PDA may develop problems related to the increased blood flow to the lungs. These patients may have improvement if the PDA is closed. Closing the PDA can now usually be performed by catheter coil placement or other device insertion to plug the abnormal communication. […] Surgery may be the best treatment option for some patients. The surgeon doesn’t have to open the heart to fix the PDA. […] If there’s no other heart defect, this restores the circulation to normal.

• #16 Patent Ductus Arteriosus (PDA) | American Heart Association

  https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heart-defects/patent-ductus-arteriosus-pda

  An unclosed hole in the main body artery (aorta). […] The ductus arteriosus is a normal fetal artery connecting the aorta and the main lung artery (pulmonary artery). The ductus allows blood to detour away from the lungs before birth. […] Sometimes, the ductus doesn’t close after birth. Failure of the ductus to close is common in premature infants but rare in full-term babies. […] In a child with PDA, extra blood gets pumped from the body artery (aorta) into the lung (pulmonary) arteries. If the PDA is large, the extra blood being pumped into the lung arteries makes the heart and lungs work harder and the lungs can become congested. […] If the PDA is large, the child may breathe faster and harder than normal. […] High pressure may occur in the blood vessels in the lungs because more blood than normal is being pumped there. Over time this may cause permanent damage to the lung blood vessels.

• #17

  https://step2.medbullets.com/cardiovascular/120004/patent-ductus-arteriosus-pda

  a persistent opening between the aorta and pulmonary artery that fails to close in the immediate postpartum period […] the ductus arteriosus is normal in utero and typically closes hours after birth […] patency of PDA is maintained by prostaglandin E2 (PGE2) synthesis and low oxygen tension […] if unfixed, a large PDA can cause left-to-right shunting in the heart, which increases pulmonary blood flow and causes alterations in the pulmonary vasculature […] shifting of blood from systemic circulation can cause cyanosis […] over time, with severe defects, this eventually results in pulmonary hypertension and Eisenmenger syndrome.

• #18 Patent Ductus Arteriosus | Clinical Heart and Vascular Center | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/patent-ductus-arteriosus/

  Patent ductus arteriosus is a congenital heart condition in which the ductus a small vessel that links the aorta to the pulmonary artery does not close after birth. […] After birth, the closure of the ductus arteriosus relies on both the release of prostaglandin and blood circulating through the pulmonary vessels. When it doesnt close, the left ventricle is strained, which can lead to high blood pressure in the lungs (pulmonary hypertension). […] Untreated, children with a PDA also can show signs of heart failure as early as their first year of life. […] A PDA can sometimes close by itself within several weeks of birth. If it doesnt close on its own, ways to close it include: Indomethacin: A nonsteroidal anti-inflammatory medication for infants with symptomatic simple PDA. […] Surgical ligation (tying) of the ductus arteriosus in these cases: Asymptomatic children older than 2 to 3, Infants with heart failure in the first year of life, Premature infants with severe pulmonary problems, Shunt flow greater than 2:1.

• #19 Patent Ductus Arteriosus (PDA): Symptoms & Causes | NewYork-Presbyterian

  https://www.nyp.org/heart/congenital-heart-disease/patent-ductus-arteriosus-pda

  Complications for large, unrepaired PDA may include: Congestive heart failure in infancy – blood is diverted from the body to the lungs, making it harder for the baby to breathe, and difficult for the baby to exert themselves (crying/eating). […] In a smaller PDA, not as much blood can travel to the lungs, and patients are usually not symptomatic. Complications from smaller PDAs include: Endocarditis due to turbulent flow through the PDA, the smooth lining of the ductus tube can be disrupted.

• #20 Patent Ductus Arteriosus – Pediatric Heart Specialists

  https://pediatricheartspecialists.com/heart-education/15-congenital-heart-defects/172-patent-ductus-arteriosus

  The ductus arteriosus is small blood vessel connecting the pulmonary artery to the aorta. […] When it fails to properly close, it is termed a patent ductus arteriosus (PDA). […] A PDA is considered a congenital heart defect, in other words, a birth defect of the heart. […] A PDA allows for oxygenated blood (red blood) to pass from the aorta backwards into the lungs. […] The amount is primarily determined by the size of the PDA. […] A large PDA can allow for a significant increase in blood flow into the lungs; a small PDA often results in a negligible increase. […] Symptoms from a PDA are related to excess blood flow to the lungs. […] In patients who develop symptoms, the most common finding is a rapid respiratory rate. […] PDAs may also predispose to an increased risk of lung infections such as pneumonia.

• #21

  https://scholars.duke.edu/publication/1495709

  Patent ductus arteriosus (PDA) is the persistence of a fetal shunt between the pulmonary artery and the aorta. This structure normally closes in the first 3 days after birth; however, closure is delayed in up to 80% of infants born at 25 to 28 weeks of gestation. Persistent PDA results in pulmonary overcirculation and systemic hypoperfusion. […] The purpose of this article is to review pathophysiology and treatment options for PDA. […] Long-term morbidities associated with PDA include chronic lung disease, retinopathy of prematurity, and neurodevelopmental delay. […] Absence of a universal scoring system for severity of PDA limits accuracy of comparisons among research studies. Lack of a consistent definition also makes it difficult to aggregate data for meta-analyses. Adoption of a consistent scoring system for hemodynamic significance would facilitate comparisons of outcomes among research studies. […] Clinicians should be aware of treatment options for PDA and their implications on neonatal outcomes.

• #22 Patent Ductus Arteriosus in Animals – Circulatory System – Merck Veterinary Manual

  https://www.merckvetmanual.com/circulatory-system/congenital-and-inherited-anomalies-of-the-cardiovascular-system/patent-ductus-arteriosus-in-animals

  Chronic volume overload and dilatation of the left-side cardiac chambers usually result in development of left-side CHF in most untreated cases within the first 12 years of life. […] In cases of severe pulmonary hypertension in which pulmonary pressures exceed systemic pressures, blood flow through the ductus can reverse and result in right-to-left shunting. This reverse PDA causes disappearance of the classic machinery murmur and results in caudal hypoxemia. […] Occlusion of the patent ductus arteriosus, either by device occlusion (Amplatz canine ductal occluder, ACDO) or surgical ligation. […] Because of the high risk of CHF early in life for animals with a PDA, timely closure is generally recommended. […] Occlusion or ligation of the ductus is contraindicated with reverse PDA due to the risk of worsening pulmonary hypertension and right heart failure.

• #23 Patent ductus arteriosus – Wikipedia

  https://en.wikipedia.org/wiki/Patent_ductus_arteriosus

  If the congenital defect transposition of the great vessels is present in addition to a PDA, the PDA is not surgically closed since it is the only way that oxygenated blood can mix with deoxygenated blood. […] Some evidence suggests that intravenous NSAIDs, such as indomethacin, administration on the first day of life to all preterm infants reduces the risk of developing a PDA and the complications associated with PDA. […] Because prostaglandin E2 is responsible for keeping the DA open, NSAIDs (which can inhibit prostaglandin synthesis) such as indomethacin or a special form of ibuprofen have been suggested as therapy to initiate PDA closure. […] While indometacin can be used to close a PDA, some neonates require their PDA be kept open. Keeping a ductus arteriosus patent is indicated in neonates born with concurrent heart malformations, such as transposition of the great vessels.

• #24 Patent ductus arteriosus – WikEM

  https://wikem.org/wiki/Patent_ductus_arteriosus

  Ductus arteriosus is a blood vessel connecting main pulmonary artery to proximal descending aorta […] In PDA, ductus fails to close […] In PDA, ductus fails to close […] Results in shunting of blood between aorta and pulmonary artery […] Some oxygenated blood from high-pressure aorta shunts to lower pressure pulmonary artery […] A large shunt can cause increased fluid return to lungs and increased lung pressure, leading to pulmonary hypertension […] Some congenital heart defects, such as transposition of the great arteries, are incompatible with life without a PDA; may be necessary to allow oxygenated and deoxygenated blood to mix […] In these cases prostaglandins are used to keep the ductus arteriosus open.

• #25 Patent Ductus Arteriosus (PDA) – Kauvery Hospital

  https://www.kauveryhospital.com/nightingale/patent-ductus-arteriosus-pda/

  The echocardiography is the gold standard bedside investigation to diagnose PDA. In addition, to make a confirmative diagnosis of PDA and exclude/diagnose any associated congenital heart defect (CHD). It can help in estimating the magnitude of shunt volume and assessing its hemodynamic significanceit can be used to assess the hemodynamic impact from pulmonary over circulation and systemic hypo perfusion due to shunt volume This could be systematically achieved by studying (a) ductal characteristics, (b) parameters of pulmonary over circulation, and (c) signs of systemic hypo perfusion. […] For infants with just an isolated PDA, the prognosis is good. In premature infants, the prognosis is dependent on other comorbidities. After closure the PDA, most children have a normal life expectancy. Spontaneous closure of the PDA is rare, with the use of indomethacin; close to 80-90% of infants will have successful closure of the PDA. In adults, a surgical closure is always required provided the patient has not developed fixed pulmonary hypertension.

• #26 NeoCardio Lab – Patent Ductus Arteriosus

  https://www.neocardiolab.com/tnecho-and-neonatal-hemodynamics/patent-ductus-arteriosus

  In the Patent ductus arteriosus view – modified upper parasternal short axis view – one may appreciate the patency of the ductus, its configuration, its course, its size and the direction of the trans-ductal flow. Measurement should be at its narrowest diameters (usually closer to the pulmonary arterial end). Doppler (CW) should be done in order to evaluate its direction and velocity. A large ductus may be associated with rapid equalization of pressure on both sides and with low velocity of flow. A restrictive small ductus with low velocity may be indicative of PA pressure closer to Aortic pressure. The large PDA will lead to rapid equalization of pressure on both sides. As such, the PDA may be associated with excessive systolic and diastolic pressure and flow in the pulmonary compartment.

• #27 NeoCardio Lab – Patent Ductus Arteriosus

  https://www.neocardiolab.com/tnecho-and-neonatal-hemodynamics/patent-ductus-arteriosus

  Definition of restrictive vs unrestrictive: „Velocity of Shunt Across PDA and Its Significance – Non-restrictive shunts have a low peak systolic velocity with a high systolic to end-diastolic velocity gradient while restrictive shunts have a high peak systolic velocity and a low systolic to diastolic velocity gradient.” […] In a large left-to-right patent ductus arteriosus (PDA), increased pulmonary venous return and left atrial (LA) volume overload significantly impact mitral inflow dynamics, particularly the E-wave (early passive filling phase of the left ventricle). During ventricular systole, the mitral valve remains closed, while continuous pulmonary venous return leads to progressive LA filling. In the presence of a large PDA, excess pulmonary blood flow results in elevated LA pressure, reducing the LV-LA pressure gradient needed for mitral valve opening. When the mitral valve opens, the E-wave velocity increases, reflecting a rapid „gush” of blood into the LV due to high preload (high LA pressure). This augmented early diastolic filling can mimic restrictive physiology in severe cases, characterized by shortened IVRT, increased E/A ratio, and shortened deceleration time due to elevated LA pressures. […] The pattern of shortened IVRT and increased E-wave velocity is a hallmark of significant left heart volume overload, commonly seen in large left to right PDAs with significant shunt volume.

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