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Cardiology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
The ductus arteriosus connects the pulmonary artery to the aorta in the foetus and closes at birth. PDA occurs if the vessel does not close. Presentation: heart failure, infective endocarditis, pulmonary hypertension may occur. Investigations: diagnosis is by echocardiography. Management: consider either indomethacin, percutaneous closure or surgery.
Miscellaneous
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Ductus arteriosusWhen: closes almost immediately following birth. The physiological closure is complete in 1–4 days. Complete obliteration into a fibrous remnant, the ligamentum arteriosum, occurs in the months following birth.How: lung expansion leads to increased bradykinin and decreased PGE2 levels whichcause contraction of the muscular wall of the ductus arteriosus and subsequent closure of the vessel.
Pediatric Imaging in General Radiography
Published in Christopher M. Hayre, William A. S. Cox, General Radiography, 2020
Allen Corrall, Joanna Fairhurst
As the neonate’s lungs naturally recoil and they start to take their first few breaths, blood fills the lung capillaries and the resistance within the pulmonary vessels falls, the airways fill with air and gaseous exchange starts within the alveoli. As the umbilical cord is clamped, the peripheral blood pressure increases causing a pressure differential within the heart closing the foramen ovale: this closes permanently with the fall in maternal hormone levels that had kept this patent in the uterus (South & Isaacs, 2012). The ductus arteriosus usually closes within a few days of birth. For the term neonate with mature lungs, the recoil and entry of air into the alveoli causes surfactant to be released. This is a substance that reduces the surface tension of the alveoli and prevents them collapsing during exhalation. In the preterm infant with immature lungs this process does not occur. If there is a high risk of premature labor the mother may be given steroids from 23 weeks gestation to aid in surfactant maturation, and the preterm neonate given surfactant soon after birth. This is one occasion when the ‘four hour rule’ for a chest X-ray is not applicable, as the exogenous surfactant has to be delivered via an appropriately sited endotracheal tube.
Congenital heart disease: addressing the need for novel lower-risk percutaneous interventional strategies
Published in Expert Review of Cardiovascular Therapy, 2023
N Linnane, DP Kenny, ZM Hijazi
Multiple studies have demonstrated that younger patients (<1 month) at catheterization is an independent risk factor for a serious adverse event during catheterization [9,18,19,21,22,41]. However, this is also likely influenced by comorbidities and the complexity of the intervention. Gestational age may be more relevant than chronological age. Prematurity has long been associated with worse outcomes in congenital heart disease [42,43]; however, while not specifically mentioned in the CRISP or rCRISP score [22], it must be taken into account. Interestingly, even late prematurity (37–39 week gestation) is associated with worse outcomes in patients with congenital heart disease [44–46]. The prevalence of congenital heart disease in premature infants is twice that of term infants [43]. Fetuses with congenital heart disease are also more likely to be born prematurely. Moreover, premature infants with congenital heart disease are more likely to have the complications of prematurity than those without [47,48]. All this leads to premature infants having a higher risk when it comes to procedures and novel lower-risk interventions being developed. This has been particularly evident in the management of the patent ductus arteriosus (PDA).
Coronary Sinus Defect, Premature Restriction of Foramen Ovale and Cysto-Colic Peritoneal Band
Published in Fetal and Pediatric Pathology, 2023
A 27 Years, gravida 2, presented with intrauterine fetal death at 24 weeks gestation due to fetal congestive cardiac failure, cardiomegaly and hydrops. Perinatal autopsy showed baby weight at 98th centile, hydrops, and enlarged liver. The venous system was engorged including brachiocephalic vein, jugular vein, inferior vena cava, renal veins and other tributaries. The heart showed absent coronary sinus with drainage of all the cardiac veins directly into the heart (Figs. 1 and 2) without the persistent left superior vena cava (type II defect). The right atrium was dilated and the foramen ovale was restricted prematurely by a thickened and folded flap (Fig. 3). The ductus arteriosus was present and nonrestrictive. The aortic root had normal left and right coronary ostia, and there was no left ventricular hypoplasia. The abdomen showed an abnormal cysto-colic peritoneal band between the gall bladder and the colon (Fig. 4).
Clinical features and echocardiographic findings of isolated foramen ovale restriction in foetuses
Published in Journal of Obstetrics and Gynaecology, 2022
Tolga Akbaş, Fadli Demir, Sevcan Erdem, Berivan Çağnıs, Ferda Özlü, Selim Büyükkurt, Nazan Özbarlas
Right ventricle and LV diastolic dimensions were measured just below the atrioventricular (AV) valves, the widest part at the end of the diastole, in the appearance of a four-chamber view. The widest length from each atrium's sidewalls to the atrial septum's edge was measured at end of systole. The dimensions of aorta and pulmonary artery and their relationship with each other were evaluated. The great arteries' dimensions were recorded by measuring their largest diameters at the end of the systole. Ventricular and atrial enlargements were determined based on published standard measurements for gestational age-based dimensional measurements. The ductal view was obtained by aligning the imaging plane with the right ventricular outflow tract and the main pulmonary artery. The ductus arteriosus (DA) was evaluated in sagittal or longitudinal axis views in 2D echocardiography. The ascending aorta's size and shape, the transverse arch, and the descending aorta were visualised. The presence of antegrade blood flow in the aorta and pulmonary artery and velocity was recorded using colour Doppler (Sharland and Allan 1992; Rychik et al. 2004; Donofrio et al. 2014).