The human circulatory system includes the main organ, the heart and the arteries leaving it, returning back from the tissues as veins. Its correct functioning is determined by the normal anatomical structure and hemodynamic conditions. If one of these two conditions is violated, the blood supply to other organs is also damaged.
Relevance
Unfortunately, the frequency of congenital malformations is increasing every year. This is due primarily to the deterioration of the environmental situation and the he alth deficiencies of the parents themselves. As pediatricians teach, you need to start preparing for the birth of a child from your childhood, thereby implying that both spouses should carefully take care of themselves when planning a family. So, for a long time before pregnancy, it is worth giving up bad habits, curing chronic diseases, the expectant mother - to correct vision, nutrition, and normalize rest. However, there are still cases when children with congenital malformations are born in a he althy family. Therefore, at different gestation periods, a woman must periodicallyundergo an ultrasound examination, which allows you to detect intrauterine disorders of the fetus. But even the diagnosis of such a process does not mean the need to terminate the pregnancy, because medicine does not stand still, and at present most congenital malformations are treated. One such striking example is the unclosed arterial (Batalov) duct.
Functions of the duct
The fetal circulatory system is significantly different from that of an adult. This is due to his special nutrition during intrauterine development - through the placenta from the mother's blood, all the substances he needs for growth, including oxygen, enter his own blood. Therefore, the need for the respiratory and digestive system for the period before birth is simply absent, while the cardiovascular system works in an enhanced mode. One of its most important features are the oval window in the interatrial septum and the Batal duct. With the help of the latter, the aorta is connected to the trunk of the pulmonary artery, and so the mother's blood, bypassing the pulmonary vessels, enters the systemic circulation of the fetus. Normally, in the first hours of a baby's life, when his lungs expand and he begins to breathe on his own, he should stenose, and during the first days, completely obliterate and turn into a ligament. However, if this does not happen, and the Batal duct remains open, then severe hemodynamic disturbances occur in the child's blood supply system.
Etiology
There are three main reasonssuch a malformation. The first is another congenital pathology with which the open Batal duct is combined, for example, Down's syndrome or Fallot's tetrad. The second is a severe course of childbirth with complications that led to hypoxia or asphyxia of the fetus. This may be their slowness, prolonged standing of the head over the entrance to the small pelvis, premature rupture of amniotic fluid, the occurrence of an ascending infection, entanglement of the neck with the umbilical cord or overlapping of the respiratory tract with fetal membranes, and many others. And finally, the third is initially, i.e. in utero, an abnormally wide or long Batal duct formed due to the influence of factors on the part of the mother on the child during the laying of the heart, that is, in the first 10 weeks of pregnancy. So, many drugs have teratogenic properties, especially hormonal, sleeping pills and antibiotics, viruses, alcohol, smoking, stressful situations. But until that time, a woman should be surrounded by exceptional care and be in a state of physical and psycho-emotional rest.
Pathogenesis
Hemodynamic disturbances in congenital heart disease such as non-closure of the Batal duct are primarily due to the discharge of blood from the aorta into the pulmonary trunk due to a pronounced pressure gradient. As a result, the pulmonary circulation is overloaded, and gradually stagnation develops in it, followed by sweating of the liquid part of the plasma into the surrounding tissues. The lungs become easily susceptible to infections, become unable to breathe normallyenrich the blood with oxygen. At the same time, due to a decrease in the volume of circulating blood in a large circle, it becomes depleted, all organs suffer from severe hypoxia, and since the baby’s body grows at maximum intensity during the first year, they need a lot of nutrients and energy. And because of the deficiency of this, their dystrophy increases, as a result of which their functioning also suffers. The child slowly gains weight, often gets sick, becomes restless, constantly screams.
Operation
However, the method of treating this pathology is not so complicated, because the only problem is the open Batal duct. The operation becomes the only option for his therapy, because conservative methods do not work on him. The defect is usually surgically corrected at the age of 5-10 years, but the best age for this is considered to be 3-5 years. The main thing is that this happens before puberty, when the hormonal background of the body is restructured, and it will need more blood supply. There are data on isolated cases of treatment in adulthood after a late diagnosis of the defect. During the operation, the Batal duct is simply sutured or ligated with a transvascular access from the femoral artery to minimize trauma to the baby's tissues. All this happens under the control of angiography and with the help of endoscopic devices. Such a mini-operation has already been actively developed by surgeons and is not difficult.
Forecast
After treatment, the disease hasfavorable outcome, life expectancy usually does not suffer. It depends on the stage of defect compensation at the time of its detection and on the degree of changes in the vascular system of the lungs. However, these patients gradually develop severe heart failure, often complicated by infective endocarditis. Even isolated cases are described when non-operated patients lived up to 70-80 years due to small deviations of the arterial duct and the strong compensatory ability of their body.
