Methods of diagnosing patent ductus arteriosus

What are the methods for diagnosing patent ductus arteriosus? In daily life, there are many diseases that threaten people's health. Patent ductus arteriosus is such a disease. It is a type of congenital heart disease and is common in newborn babies. So, what are the methods for diagnosing patent ductus arteriosus?

1. Diagnosis

(I) Key points of medical history collection

White children are prone to colds, flu and respiratory infections, and are prone to fever. They generally have poor development. Those with thick ducts and large shunt volumes are prone to palpitations and shortness of breath after activities; those with thin ducts and small shunt volumes often have no obvious clinical symptoms.

(II) Key points of physical examination

1. The pulsation of the blood vessels in the neck is enhanced, the pulse pressure is increased, and the arteries in the limbs may have water-rushing pulses and shooting sounds.

2. The pulse pressure widens as the shunt volume increases.

3. Cardiac examination: The apex beat is enhanced and shifted to the lower left, and the heart dullness boundary expands to the lower left. There is a loud continuous murmur on the lateral side of the second intercostal space on the left side of the sternum, which is transmitted to the upper left neck and back, accompanied by systolic or continuous fine tremor. After the occurrence of pulmonary hypertension, only the systolic murmur may be heard. The second sound of the pulmonary artery is hyperactive and split, and the pulmonary valve may have a diastolic murmur of relative insufficiency. When the shunt volume is large, there is a short mid-diastolic murmur at the apex due to the increase and acceleration of blood flow through the mitral valve orifice.

2. Diagnostic Criteria

1. Diagnostic criteria established by the New York Heart Association Standards Committee

(1) A cardiac catheter is passed from the left pulmonary artery into the descending aorta.

(2) During selective retrograde aortography, the pulmonary artery is visualized through the patent ductus arteriosus.

The disease can be diagnosed if one of the above criteria is met.

2. Diagnostic conditions

(1) Those with a small shunt flow have no symptoms, while those with a larger shunt flow are prone to shortness of breath, palpitations, coughing, hemoptysis, etc. after activities; in the late stage, there is heart failure.

(2) There is a loud, continuous machine-like murmur at the second intercostal space on the left side of the sternum, which increases in systole and decreases in diastole, accompanied by a hyperactive second heart sound in the pulmonary valve area and peripheral vascular signs.

(3) X-ray examination: ① Those with mild lesions are normal; ② Those with large shunt volume have enlarged left atrium and left ventricle, thickened pulmonary artery shadow, increased pulsation, bulging pulmonary artery segment, widened aortic node, and visible funnel sign.

(4) There are four types of changes in the electrocardiogram and vectorcardiogram: normal, left ventricular hypertrophy, bilateral ventricular hypertrophy, and right ventricular hypertrophy.

(5) Echocardiography: The left ventricular internal diameter increases, and the amplitude and velocity of mitral valve activity increase. Two-dimensional ultrasound can show a patent ductus arteriosus.

(6) One or more of the following changes were found during right cardiac catheter examination: ① The cardiac catheter entered the descending aorta from the left pulmonary artery; ② The oxygen content in the pulmonary artery blood was more than 0.5% higher than that in the right ventricular blood; ③ The horizontal curve of the pulmonary artery measured by the dilution curve arrived earlier than expected, and the arrival time was less than 4 seconds.

(7) Selective cardiovascular angiography: The aortic arch is visualized while the pulmonary artery is also visualized.