Otvoreni arterijski duktus u djece

master's thesis

• Title (english): Patent ductus arteriosus in children
• Author: Matea Melša
• Mentor: Daniel Dilber (mentor)
• Committee member: Ivan Malčić (predsjednik povjerenstva)
• Committee member: Ruža Grizelj (član povjerenstva)
• Committee member: Daniel Dilber (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Arterijski duktus, mišićna arterija koja spaja aortu i pulmonalnu arteriju, normalna je struktura u fetalno doba. Ona postaje patološka ako ostane otvorena nakon rođenja, pri čemu je nedonoščad najčešće zahvaćena. Osim nedonošenosti, razmatraju se i neki od drugih mogućih uzroka (kromosomske aberacije, genetski utjecaji, onečišćenje okoliša). Pojava otvorenog arterijskog duktusa u obitelji je rijetka, a smatra se da je uobičajeni mehanizam nasljeđivanja poligenski, s učestalosti od oko 3%. Klinički znakovi i simptomi mogu varirati ovisno o dobi oboljelog djeteta te veličini i hemodinamskoj značajnosti duktusa. Klinička sumnja na otvoreni arterijski duktus mora se potvrditi, uglavnom transtorakalnom ehokardiografijom. Postoji nekoliko načina liječenja. Nedonoščad i djeca niske porođajne težine s PDA om liječe se inhibitorima ciklooksigenaze, a on je kod njih povezan sa značajnim komorbiditetima i mortalitetom zbog hemodinamske nestabilnosti. Transkatetersko zatvaranje duktusa uobičajeno je kod starije djece. Kirurško zatvaranje posljednja je opcija budući da je povezana s većim rizikom od nastanka komlikacija u odnosu na prethodna dva. Asimptomatski pacijenti s malenim duktusom imaju normalnu prognozu, dok pacijenti s umjerenim ili velikim duktusom i značajnom hemodinamskom nestabilnošću mogu razviti ireverzibilne promjene na plućnim krvnim žilama i plućnu hipertenziju te je upravo stoga vrlo važno dijagnosticirati i izliječiti ih na vrijeme.

Abstract (english)

The ductus arteriosus, a muscular artery connecting aorta and pulmonary artery, is a normal structure during fetal life. It becomes pathological if it remains patent after birth, with preterm infants being most commonly affected. Besides from prematurity, some of the other possible causes are being evaluated (chromosomal abnormalities, genetic influences, environmental pollution). Familial occurrence of PDA is uncommon and the usual mechanism of inheritance is considered to be polygenic with a recurrence risk of 3%. Clinical sings and symptoms may vary depending on the age of the child affected and the size and hemodynamic significance of the ductus. A clinical suspicion of patent ductus arteriosus has to be confirmed, usually with transthoracic electrocardiography. There are several methods of treatment. PDA in preterm and low birth weight infants is treated with cyclooxygenase inhibitors and the condition is associated with significant co morbidity and mortality due to haemodynamic instability. Transcatheter closure of the duct is usually indicated in older children. Surgical closure is the last option because it is related to grater risk of complications than the previous two. Asymptomatic patients with a small duct have a normal vital prognosis. Patients with moderate or large ducts with significant haemodynamic alterations may develop irreversible changes to pulmonary vascularity and pulmonary hypertension and it is of great importance to diagnose and close them in time.

• Keywords: otvoreni arterijski duktus; nedonoščad; inhibitori ciklooksigenaze; transkatetersko zatvaranje
• Keywords (english): persistent ductus arteriosus; preterm; cyclooxygenase inhibitors; transcatheter closure
• Language: croatian
• URN:NBN: urn:nbn:hr:105:811905
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-12 08:04:58