Can patent ductus arteriosus be completely cured?

Can patent ductus arteriosus be completely cured? The prevalence of congenital diseases in children is gradually increasing, which poses a great threat to children. Patent ductus arteriosus is one of them. Some parents are worried that this disease cannot be cured, so they are very afraid. So, can patent ductus arteriosus be completely cured? The answer is yes. Let's take a look at the treatment methods of patent ductus arteriosus.

1. Surgical method

1. Catheter ligation is divided into simple ligation and padded ligation.

(1) Simple ligation method: use two thick threads to wrap around the catheter for double ligation, or make a purse string ligation on the aorta side, or add a through suture ligation between the two ligatures. It is suitable for patients with slender and elastic catheters.

(2) Padding ligation method: Use a polyester cloth piece as wide as the length of the catheter, roll it into a cylindrical shape slightly thinner than the diameter of the catheter, sew its free edge to the roll body, and keep the thread after tying in the middle of the cloth roll for use, and sew the two ends of the cloth roll together to prevent it from loosening. Place the cloth roll on the catheter in a straight line, and tie it to the catheter with two thick threads that pass around the catheter, and tie the two ligatures to the sutures left on the cloth roll to prevent the roll pad from sliding.

2. For catheter cutting and suturing, use two special non-traumatic catheter clamps to clamp the aortic and pulmonary artery ends of the catheter respectively. If the catheter is short, the aortic end can be clamped on the descending aorta with a long curved arterial clamp or a Potts-Smith clamp to extend the length of the catheter. Use 3-0 non-traumatic needle and thread to continuously suture the aortic end of the catheter between the two clamps while cutting. After the catheter is cut, suture continuously back to the starting point of the needle to make a knot, and then suture the pulmonary artery end of the catheter continuously back and forth.

3. Catheter clamping is suitable for catheters with a diameter of less than 2 cm and good wall elasticity. Use a special arterial catheter clamp to clamp the aortic end and pulmonary artery end of the catheter once each, so that the rows of titanium staples in the clamp pass through the front and back walls of the catheter and bend to press it closed (stapler principle). Due to the small local operating space, it is sometimes difficult to properly place the clamp, and it may even cause damage to the catheter wall and bleeding, so you should be vigilant.

2. Radiological interventional treatment can now also be used for funnel-shaped patent ductus arteriosus.

3. Treatment of patent ductus arteriosus in premature infants

1. If the ductus arteriosus does not close at 24 s after indomethacin treatment, symptoms do not improve, and hypoxemia and hypercapnia persist despite adequate ventilation and oxygen support, and PC02>7.98kPa (60mmHg), simple ductus ligation should be performed urgently.

2. Indomethacin treatment: Patients who have not responded to anti-heart failure treatment should be given indomethacin by nasogastric feeding. One dose every 8 hours, for a total of 3 times. Before medication, the white blood cell count should be within the normal range, platelets should be no less than 60×109/L (60,000/mm3), urea nitrogen <20mg, and bilirubin <12mg. Urine volume, heart rate, appetite, and jaundice should be observed during medication. After medication, urea nitrogen, electrolytes, echocardiography, and chest X-ray should be reviewed. Adverse reactions of indomethacin include renal failure, hyponatremia, worsening jaundice, bone marrow suppression causing thrombocytopenia and coagulation disorders.

4. Medical treatment: prevent and treat infective endocarditis, respiratory tract infection and heart failure. For premature infants with patent ductus arteriosus, 0.2-0.3 mg/kg of indomethacin or 20 mg/kg of aspirin can be taken orally 4 times a day to inhibit prostaglandin synthesis and close the ductus. For older children or adults with pulmonary hypertension, tamponade or closure agents can be injected through the catheter to block the shunt.

Among them, for the treatment of arterial catheters, in order to improve the safety of arterial catheter closure, gauze can be placed on the aorta near and distal to the catheter before freeing and handling the catheter, so that the gauze can be tightened to control bleeding in case of an accident. Before the catheter closure operation, the anesthesiologist will give appropriate antihypertensive measures to maintain the systolic arterial blood pressure at around 12.0 kPa (90 mmHg), which will help reduce the chance of catheter rupture and bleeding.