What are the prevention and treatment methods for patent ductus arteriosus?

What are the prevention and treatment methods for patent ductus arteriosus? Patent ductus arteriosus in children can cause serious harm to the child's health, so parents are particularly worried. Therefore, many parents want to know the specific prevention and treatment methods for patent ductus arteriosus in order to get their children treated and recovered as soon as possible.

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1. Premature infants For premature infants, the intake of fluids and sodium salts needs to be restricted in the early stage. For premature infants with a birth weight of less than 1000g, intravenous infusion of indomethacin (Indomethacin) within 10 days after birth can effectively close the ductus arteriosus. However, it is contraindicated for children with renal insufficiency, necrotizing enterocolitis and bleeding tendency, and renal function needs to be closely monitored during treatment. Recently, intravenous infusion of ibuprofen (ibuprofen) has been used to promote the closure of the ductus arteriosus. The efficacy is equivalent to that of indomethacin (Indomethacin) and it rarely causes oliguria. Ibuprofen is given in 3 doses, with the first dose of 10mg/kg, and then 5mg/kg is used twice in the next 24 hours. The ductus closure rate can reach 70%. For those whose heart failure cannot be corrected after treatment, surgical ligation of the ductus arteriosus is required. Arterial duct ligation can be performed in the neonatal intensive care unit to avoid the emergency state that may occur during transfer to the operating room. Surgical complications are rare, but may include ductal tear, phrenic nerve paralysis, chylothorax, and accidental ligation of the left pulmonary artery and descending aorta. Therefore, it is necessary to check the femoral artery pulse after surgery. For premature infants with a birth weight of ≤1000g, preventive arterial duct ligation on the day of birth has been found in a randomized, controlled clinical study to reduce the incidence of necrotizing enterocolitis.

2. For term infants and older children with severe left-to-right shunts, closure of the ductus arteriosus can correct heart failure and eliminate the risk of eventual development of pulmonary vascular disease. To prevent infective endocarditis, ligation of the ductus arteriosus is recommended even for small shunts, especially since the complications and mortality of this procedure are relatively low. However, ligation of the ductus arteriosus is controversial simply to eliminate the risk of infective endocarditis.

3. Percutaneous transcatheter arterial duct occlusion Currently, transcatheter interventional treatment for occluding patent arterial ducts is superior to surgical ligation. From the early 1970s to the late 1980s, before the widespread use of the Rashkind double umbrella device, arterial duct transcatheter occlusion was only occasionally attempted. However, the Rashkind double umbrella is now rarely used due to its high price, the need for a larger transvenous sheath and a relatively high residual shunt rate of nearly 10% to 20%. It has been reported that a small number of patients may still experience intravascular hemolysis and left pulmonary artery blood flow disturbances.

4. Surgical treatment: Surgical ligation of the ductus arteriosus has a residual shunt rate of 0.4% to 3.1% clinically. Using more sensitive color Doppler ultrasound detection, the residual shunt rate may be higher. Therefore, for some patients with recanalization and a tube diameter of more than 7 to 10 mm who need surgery, the ductus arteriosus should be cut off. However, in most medical centers, surgical treatment is currently limited to premature infants who have failed drug treatment or have contraindications to treatment. Recently, thoracotomy through a small axillary incision has been carried out for newborns and infants, and has achieved widely recognized results. Thoracoscopic surgery has been successfully used to close the ductus arteriosus in children. The surgical steps include placing a vascular clip under direct vision of the thoracoscope. A skilled doctor can complete it within 20 minutes. This new technology has been extended to premature infants and infants, and complications include pneumothorax and recurrent laryngeal nerve injury. The accumulation of experience can reduce the occurrence of such complications.

5. Asymptomatic patent ductus arteriosus With the application of color Doppler technology, the weak turbulence caused by some small ductus arteriosus without clinical symptoms can also be detected. It is reported that among children who underwent color Doppler ultrasound examination due to the discovery of murmurs unrelated to the blood flow of patent ductus arteriosus, about 0.5% were found to have asymptomatic patent ductus arteriosus. There was a report showing that a patient with asymptomatic patent ductus arteriosus suffered from endarteritis. Whether the asymptomatic ductus arteriosus should be routinely closed needs further discussion.