Andersons pediatric cardiology 1075

41 Arterial Duct Its Persistence and Its Patency Lee N Benson, Diane E Spicer, Robert H Anderson Abstract The arterial duct is a fetal blood vessel that is programmed to close shortly after birth If the vessel remains patent beyond 3 months of life (a persistently patent arterial duct) it can result in volume loading of the left heart and should be closed either surgically or by a catheter-based procedure A patent arterial duct is common in the newborn, particularly premature infants, and can contribute to persistent respiratory problems Early symptoms are uncommon but may include dyspnea and failure to thrive in the most extreme cases An uncorrected patent duct may lead to congestive heart failure with increasing age In some congenital heart lesions (e.g., atrioventricular concordance, ventriculoatrial discordance) a patent duct is the only pathway where oxygenated blood can mix with deoxygenated blood In such cases, prostaglandins are infused to keep the duct open Nonsteroidal antiinflammatory drugs can be used to close the duct in the premature infant but should not be administered to those with congenital heart disease, in whom the duct is used to augment pulmonary blood flow or maintain systemic flow in left heart obstructive lesions This chapter details what controls ductal patency, its pathophysiology, and its effect on the circulation in heath and disease Keywords Patent arterial duct; patent ductus arteriosus; prostaglandins; ductal stent; indomethacin; Amplatzer duct occluder; hybrid procedure All these arrangements are marvelous, without any question But we have to consider that it exceeds all expectations how soon the occlusion of all these openings takes place R.E SIEGAL