How to identify patent ductus arteriosus

How to identify patent ductus arteriosus? The occurrence of patent ductus arteriosus makes many parents start to worry. When a child suffers from this disease, many symptoms will appear, which will harm the child's health and need our attention. How to identify patent ductus arteriosus?

The ductus arteriosus is a physiological blood flow channel between the pulmonary artery and the aorta during the fetal period, which adapts to the special circulation state of the fetus without lung breathing. There are many left-to-right shunt intracardiac malformations that can hear the same continuous machine-like murmur or nearly continuous biphasic heart murmur at the left edge of the sternum, which is difficult to identify. It must be identified before establishing a diagnosis of patent ductus arteriosus and conducting treatment.

1. Physical examination: A fine systolic thrill can be felt at the second intercostal space on the left side of the sternum, which can extend to the diastolic period. Auscultation of this area can produce a continuous mechanical murmur that is transmitted to the left subclavian fossa. The pulse pressure difference is widened, and there may be capillary pulsation, water pulse, and gunshot sound in the limb arteries.

2. Auxiliary examinations: Electrocardiogram: Those with a smaller shunt volume may be normal or have a high left ventricular voltage. Those with a larger shunt volume may have left ventricular hypertrophy. Those with pulmonary hypertension may have biventricular hypertrophy or right ventricular hypertrophy. X-ray: The texture of both lungs increases and thickens, the heart shadow may be enlarged to varying degrees, the aortic node is widened and has a funnel sign. The pulmonary artery segment is straight or bulging. B-ultrasound: A tubular connection can be seen between the descending aorta and the pulmonary artery, and Doppler can see blood shunting from the aorta to the pulmonary artery. Right cardiac catheterization: Increased blood oxygen can be seen in the pulmonary artery level, and the pulmonary artery pressure can be directly measured. Sometimes the catheter can be passed from the pulmonary artery to the descending aorta through the ductus arteriosus. Ascending aortic angiography: When the descending aorta is visualized, the pulmonary artery is also visualized, and the ductus arteriosus can be seen.

3. Differential diagnosis: The clinical diagnosis of typical patent ductus arteriosus is not difficult, but the following diseases may cause continuous murmurs in the precordial area and should be carefully differentiated:

(1) Aortopulmonary septal defect: This disease is relatively rare. The symptoms are severe, the murmur is located low, and is loudest at the 3rd and 4th intercostal spaces on the left side of the sternum. Chest X-ray shows that the aortic node is small or not significantly enlarged. Right cardiac catheter examination can confirm the diagnosis if the catheter enters the ascending aorta through the defect. Ascending aortic retrograde angiography can be performed if necessary.

(2) Ventricular septal defect combined with aortic regurgitation: The murmur of this disease is located low, and systolic and diastolic murmurs can be heard at the 3rd and 4th intercostal spaces on the left side of the sternum. Right cardiac catheter examination shows left-to-right shunt at the ventricular level.

(3) Rupture of aortic sinus aneurysm: This disease often develops suddenly, and symptoms of heart failure often appear after physical activity. A superficial, rough, continuous murmur can be heard in the precordial area. If the sinus aneurysm ruptures into the right heart, right cardiac catheter examination will show increased blood oxygen content in the right atrium or right ventricle. Ascending aortic angiography can confirm the diagnosis.

(4) Coronary artery-cardiac fistula: The murmur may occur in various parts of the precordial area. The diagnosis is confirmed by ascending aortography.