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Ductus arteriosus

DUCTUS ARTERIOSUS PERSISTENS

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1. Definitie

De ductus arteriosus is een embryonale verbinding tussen de aorta en de arteria pulmonalis.  Deze sluit in principe bij de geboorte maar kan in uitzonderlijke gevallen blijven bestaan (persistens)

 

2. Oorzaken

risicofactoren
- preterme geboorte
- hypoxie (vb grote hoogte)
- verhouding vrouw/man = 2/1
- congenitale afwijkingen: hartafwijkingen

- prostaglandines (Rubella van de moeder)

 

3. Kliniek

- asymptomatisch indien het een kleine ductus betreft
- indien grotere ductus:
- chronisch hartfalen
- recidiverende longinfecties

- groeiretardatie

 

4. Diagnose

- klinisch onderzoek
- prominente pulsatie thv apex van het hart
- trilling thv 2e intercostaal links.  Deze straalt uit naar de apex langs de linkerrand van het sternum.  Er is ook een geruis over deze regio bij auscultatie
- groot verschil in bloeddruk systolisch en diastolisch
RX-thorax
- kleine kinderen: normaal
- grotere kinderen en volwassenen: intrapulmonaire calcificaties en vergroot linker ventrikel, linker atrium, aorta descendens, pulmonale arteries
- Electrocardiogram
- abnormaal bij grote ductus: tekens van hypertrofie van het linker ventrikel en ernstige vergroting van het rechter ventrikel.
- echocardio
- hartcatheterisatie

 

5. DD

- veneus geruis: abnormale verbinding tussen vena pulmonalis en vena innominata
- aortopulmonair septumdefect
- ruptuur Valsalva sinus
- coronaire aterioveneuze fistels
- abnormale oorsprong van linker coronair thv arteria pulmonalis
- pulmonalisklepafwijking (atresie? afwezig?)
- combinatie van aortainsufficientie en ventrikelseptumdefect
- perifere stenose pulmonair

 

 

Eerste opvang

- zuurstof

 

Spoeddienst

- beperking van vocht en zout
- correctie van anemie tot hematocriet > 45%
- endocarditisprofylaxe: antibiotica

 

7. verloop

- preterme pasgeborene
- sluit meestal nog spontaan
- varieert met de graad van shunting
- indometacine: eerste 2-7 levensdagen om aanmaak van prostaglandines te remmen.  0,2 - 0,25 mg/kg/dosis elke 24u, 3 dagen lang
- à terme pasgeborene
- zelden spontane sluiting
- indicatie voor chirurgische sluiting

- of sluiting via transfemorale catheter

 

REFERENTIES:

 

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