Wheeler Craig R, Sen Shawn, Levy Philip T
Department of Respiratory Care & ECMO, Boston Children's Hospital, Boston, MA, USA.
Division of Neonatology and Pediatric Cardiology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Perinatol. 2022 Dec;42(12):1708-1713. doi: 10.1038/s41372-022-01449-8. Epub 2022 Jul 15.
The ductus arteriosus (DA) has a paradoxical biological role in neonates with congenital heart disease (CHD) and can present with significant management challenges. Critical congenital cardiac lesions rely on the patency of the DA to provide either systemic or pulmonary blood flow. A patent DA (PDA) that remains open can also have adverse consequences depending on the degree of systemic to-pulmonary shunting and volume of ductal steal. As such, the presence of a PDA may pose a challenge in the medical management and timing of surgical repair. In this perspective article, we provide an understanding of the role of the DA in the circulatory system in neonates with CHD and discuss traditional and emerging approaches to support the pulmonary and systemic circulations with manipulation of the DA.
动脉导管（DA）在患有先天性心脏病（CHD）的新生儿中具有矛盾的生物学作用，并且可能带来重大的管理挑战。严重的先天性心脏病变依赖于DA的通畅来提供体循环或肺循环血流。持续开放的动脉导管未闭（PDA）也可能产生不良后果，这取决于体肺分流程度和导管窃血的量。因此，PDA的存在可能在药物管理和手术修复时机方面构成挑战。在这篇观点文章中，我们阐述了DA在患有CHD的新生儿循环系统中的作用，并讨论通过操纵DA来支持肺循环和体循环的传统及新出现的方法。
