Patent ductus arteriosus (review): history, anatomy and physiology of a functioning duct

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Fetal communication in the vascular system of the fetus is necessary for fetal blood circulation. Metabolic support is provided through the placenta and vessels of the umbilical cord. The function of the arterial duct (ductus arteriosus) is the main component of the fetal blood circulation, which acts as a link between the pulmonary artery and aorta when the baby’s lungs are not functioning and the placenta is the gas exchange organ. Disorders occurring in the physiological processes of the cardiovascular system, especially in the intranatal period, can lead to the development of severe pathology. One of the most important defects in the structure and, consequently, in the nature of the blood flow, is the failure of the arterial duct. The patent ductus arteriosus is a necessary anatomical structure at the heart of the fetal circulatory system. Normally, the patent ductus arteriosus (PDA) must close soon after birth, turning into a ligamentum arteriosum. If there is no closure of the duct or its partial obliteration occurs, then it means there is the presence of the defect. The references to it go far into antiquity. This review presents the main stages of study, anatomical and physiological features of the ductus arteriosus.

Full Text

Restricted Access

About the authors

Linard Yu. Artyukh

St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: l-artyukh@mail.ru

Assistant Lecturer, Department of Human Anatomy

Russian Federation, Saint Petersburg

Natalia R. Karelina

St. Petersburg State Pediatric Medical University

Email: karelina_nr@mail.ru

MD, PhD, Dr. Sci. (Med.), Professor, Head, Department of Human Anatomy

Russian Federation, Saint Petersburg

Olga L. Krasnogorskaya

St. Petersburg State Pediatric Medical University

Email: krasnogorskaya@yandex.ru

MD, PhD, Assistant Professor, Department of Pathological Anatomy with a course of forensic medicine

Russian Federation, Saint Petersburg

References

  1. Aleksi-Meskhishvili VV, Kozlov YuA. Surgical treatment of open ductus arteriosus in premature infants. Russian Journal of Pediatric Surgery. 2018;22(3):148–154. (In Russ.) doi: 10.18821/1560-9510-2018-22-3-148-154
  2. Bakulev AN, Meshalkin EN. Vrozhdennye poroki serdtsa. Patologiya, klinika, khirurgicheskoe lechenie. Moscow: Medgiz; 1955. 415 p. (In Russ.)
  3. Bespalova ED. Ekhokardiografiya ploda (algoritm issledovaniya): Posobie dlya vrachei / L.A. Bokeriya, ed. Moscow: Nauchnyj centr serdechno-sosudistoj hirurgii im. Bakuleva AN. RAMN, 2004. 24 p. (In. Russ.)
  4. Bokeriya LA, Berishvili II. Khirurgicheskaya anatomiya serdtsa. Vol. 2. Vrozhdennye poroki serdtsa i patfiziologiya krovoobrashcheniya. 2nd edition. Moscow: NTsSSKh im. Bakuleva AN. RAMN, 2009. 400 p.
  5. Bokeriya EL, Degtyareva EA. Patent ductus arteriosus — good and evil in one vessel. Vestnik RUDN. 2017;21(2):163–170. (In Russ.) doi: 10.22363/2313-0245-2017-21-2-163-170
  6. Burov AA, Degtyarev DN, Ivanov DO, et al. Otkrytyi arterial’nyi protok u nedonoshennykh detei. Klinicheskie rekomendatsii. Moscow: GEOTAR-Media; 2019. P. 139–153. (In Russ.)
  7. Galkin NYa. Topograficheskaya anatomiya arterial’nogo (botallova) protoka u detei i ee prakticheskoe znachenie [dissertation]. Moscow; 1964. 11 p. (In Russ.)
  8. Garvei U. Anatomicheskoe issledovanie o dvizhenii serdtsa i krovi u zhivotnykh / K.M. Bykov, ed. Leningrad: Izd-vo Akad. nauk SSSR, 1948. 235 p. (In Russ.)
  9. Zin’kovskii MF. Vrozhdennye poroki serdtsa / A.F. Vozianova, ed. Kiev: Kniga plyus; 2008. 1168 p. (In Russ.)
  10. Ivanov DO, Aleksandrova EM, Arutyunyan TG, et al. Rukovodstvo po perinatologii: V dvukh tomakh, 2th edition. Saint Petersburg: Inform-Navigator; 2019. 1592 p. (In Russ.)
  11. Ivanov DO, Atlasov VO, Bobrov SA, et al. Rukovodstvo po perinatologii. Saint Peterburg: Inform-Navigator; 2015. 1216 p. (In Russ.)
  12. Ivanov DO, Pshenisnov KV, Aleksandrovich YuS. Features of intensive care of congenital heart malformations in newborns. Journal Pediatria named after G.N. Speransky. 2020;99(3):200–207. (In Russ.) doi: 10.24110/0031-403X-2020-99-3-200-207
  13. Murav’ev MV. Otkrytyi arterial’nyi protok: Uchebnoe posobie dlya vrachei. Moscow. 1966. 76 p. (In Russ.)
  14. Prijma NF, Popov VV, Ivanov DO. Echocardiography in the differential diagnosis of patent ductus arteriosus in children. Pediatrician. 2016;7(4):119–127. (In Russ.) doi: 10.17816/PED74119-127
  15. Shabalov NP, Ivanov DO, Kolbin AS, et al. Neonatologiya. 7th edition. Moscow: GEOTAR-Media; 2020. 752 p. (In Russ.) doi: 10.33029/9704-5771-9-NEO-2020-1-752
  16. Sharykin AS. Vrozhdennye poroki serdtsa: rukovodstvo dlya pediatrov, kardiologov, neonatologov. 2th ed. Moscow: BINOM; 2009. 381 p. (In Russ.)
  17. Kurenkova IG, Silin VA, et al. Pokori serdtsa: kliniko-instrumental’naya diagnostika: Uchebnoe posobie / G.M. Yakovleva, ed. Leningrad: Pechatnyi dvor im. A.M. Gor’kogo; 1989. 420 p. (In Russ.)
  18. Allan LD. Congenital heart disease. Heart. 2000;83:367–370.
  19. Allan LD, Sharland GK, Milburn A, et al. Prospective diagnosis of 1,006 consecutive cases of congenital heart disease in the fetus. J Amer Coll Cardiol. 1994;23(6): 1452–1458. doi: 10.1016/0735-1097(94)90391-3
  20. Backer CL, Mavroudis C. Congenital heart surgery nomenclature and database project: patent ductus arteriosus, coarctation of the aorta, interrupted aortic arch. Ann Thorac Surg. 2000;69(4 Suppl):S298–307. doi: 10.1016/s0003-4975(99)01280-1
  21. Banieghbal B. Physiological marker and surgical ligation of patent ductus arteriosus in neonates. Afr J Paediatr Surg. 2016;13(3):109–113. doi: 10.4103/0189-6725.187796
  22. Bixler M, Powers G, Clark RH, et al. Changes in the diagnosis and management of patent ductus arteriosus from 2006 to 2015 in united states neonatal intensive care units. J Pediatr. 2017189:105–112. doi: 10.1016/j.jpeds.2017.05.024
  23. Bonilla-Musoles FM, Raga F, Ballester MJ, et al. Early detection of embryonic malformations by transvaginal and color Doppler sonography. J Ultrasound Med. 1994;13(5):347–355. doi: 10.7863/jum.1994.13.5.347
  24. Chock VY, Punn R, Oza A, et al. Predictors of bronchopulmonary dysplasia or death in premature infants with a patent ductus arteriosus. Pediatr Res. 2014;75(4):570–575. doi: 10.1038/pr.2013.253
  25. Christie A. Normal closing time of the foramen ovale and the ductus arteriosus: an anatomic and statistical study. Am J Dis Child. 1930;40(2):323–326. doi: 10.1001/archpedi.1930.01940020099008
  26. Clyman RI, Couto J, Murphy GM. Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all? Semin Perinatol. 2012;36(2): 123–129. doi: 10.1053/j.semperi.2011.09.022
  27. Corun AG, Cabal L, Siassi B, et al. Surgical closure of patent ductus arteriosus in the premature infant with respiratory distress. J Pedialric Sorg. 1975;10(3): 399–404. doi: 10.1016/0022-3468(75)90103-7
  28. Dunn PM. Andreas Vesalius (1514–1564), Padua, and the fetal “shunts”. Arch Dis Child Fetal Neonatal Ed. 2003;88(2): F157–F159. doi: 10.1136/fn.88.2.f157
  29. Edwards J.E. Congenital malformation of the heart and great vessels. In: Gould SE, ed. Phatology of the heart. Springfield IL: Cherles C Thomas, 1953.
  30. Elzenge NJ, Gittenberger-de Croot AС. The ductus arteriosus and stenosis of the pulmonary arteries in pulmonary atresia. Int J Cardiol. 1986;11(2):195–208. doi: 10.1016/0167-5273(86)90179-8
  31. Gittenberger-de Croot AС. Persistent ductus arteriosus: most probably a primary congenital malformation. Br Heart J. 1977;39(6):610–618. doi: 10.1136/hrt.39.6.610
  32. Gittenberger-de Croot AС. Structural variation of the ductus arteriosus in congenital heart disease and in persistent fetal circulation. In: M.J. Godman, ed. Pediatric Cardiology. Vol. 4. Edinburgh: Churchill Livingstone, 1981.
  33. Hamrick SE, Hansmann G. Patent ductus arteriosus of the preterm infant. Pediatrics. 2010;125(5): 1020–1030. doi: 10.1542/peds.2009-3506
  34. Knight DB. The treatment of patent ductus arteriosus in preterm infants. A review and overview of randomized trials. Semin Neonatol. 2001;6(1):63–73. doi: 10.1053/siny.2000.0036
  35. Krichenko A, Benson LN, Burrows, et al. Angiographic classification of the isolated, persistently patent ductus arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol. 1989;63(12):877–880. doi: 10.1016/0002-9149(89)90064-7
  36. Langer C. The ductus arteriosus / D.E. Cassels, Ch. Thomas, eds. Springfield IL: Cherles C Thomas, 1973. P. 49.
  37. Malik PK, Ahmad M, Rani A, Dwivedi S. The men who packed the truant notes in heart sounds. Astrocyte. 2015;1(4):305–308. doi: 10.4103/2349-0977.161627
  38. Mitra S, Florez ID, Tamayo ME, et al. Effectiveness and safety of treatments used for the management of patent ductus arteriosus (PDA) in preterm infants: a protocol for a systematic review and network meta-analysis. BMJ Open. 2016;6(7): e011271. doi: 10.1136/bmjopen-2016-011271
  39. Ode E. The ductus arteriosus. Thesis. University of Leiden, the Netherlands, 1951.
  40. Rudolph AM. The changes in the circulation after birth. Their importance in congenital heart disease. Circulation. 1970;41(2):39–59. doi: 10.1161/01.cir.41.2.343
  41. Semberova J, Sirc J, Miletin J, et al. Spontaneous closure of ductus arteriosus in infants <1500 g. Pediatrics. 2017;140(2): e20164258. doi: 10.1542/peds.2016-4258
  42. Sutherland JL. Treatment of patent ductus arteriosus. Heart Dis Stroke. 1994;3(6):338–344.
  43. Tauzin L, Joubert C, Noel AC, et al. Effect of persistent patent ductus arteriosus on mortality and morbidity in very low-birthweight infants. Acta Paediatr. 2012;101(4):419–423. doi: 10.1111/j.1651-2227.2011.02550.x
  44. Weichert J, Hartge DR, Axt-Fliedner R. The fetal ductus arteriosus and its Abnormalities. A review. Congenit Heart Dis. 2010;(5):398–408. doi: 10.1111/j.1747-0803.2010.00424.x
  45. Weisz DE, Mirea L, Rosenberg E, et al. Association of patent ductus arteriosus ligation with death or neurodevelopmental impairment among extremely preterm infants. JAMA Pediatr. 2017;71(5):443–449. doi: 10.1001/jamapediatrics.2016.5143

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Blood circulation of the fetus (a) and newborn baby (b) [10]

Download (207KB)
Indexing metadata
3. Fig. 2. Leonardo Botallo of Pavia, (1530–1600) [13]

Download (119KB)
Indexing metadata
4. Fig. 3. Claudius Galen (131–199) [8]

Download (162KB)
Indexing metadata
5. Fig. 4. William Harvey (1578–1657) [8]

Download (186KB)
Indexing metadata
6. Fig. 5. Julius Cesare Aranzio of Bologna (1530–1589) [28]

Download (148KB)
Indexing metadata
7. Fig. 6. Gabriele Fallopius of Padua (1523–1562) [28]

Download (110KB)
Indexing metadata
8. Fig. 7. Hieronymus Fabricius of Padua (1537-1619) [8]

Download (230KB)
Indexing metadata
9. Fig. 8. Heart (B), lungs (C), main vessels (A — descending aorta; H — brachiocephalic trunk, left common carotid artery, left subclavian artery; F — pulmonary trunk; G — left pulmonary artery) and ductus arteriosus (E) (from Fabricius’ “De formato foetu”, 1600) [28]

Download (288KB)
Indexing metadata
10. Fig. 9. Page of H. Fabricius’ book “The Foot Deformer”, 1600: title, page 27

Download (293KB)
Indexing metadata
11. Fig. 10. Pages of H. Fabricius’ book “Deformato foutu”, 1600: page 23 and illustrations to it

Download (253KB)
Indexing metadata
12. Fig. 11. Placenta, umbilical cord, liver and venous duct (from Fabricius’ “De formato foetu”, 1600) [28]

Download (198KB)
Indexing metadata
13. Fig. 12. John Richard Farre (1775–1862) [43]

Download (223KB)
Indexing metadata
14. Fig. 13. J.R. Farre’s monograph “The Malformation of the Heart” (London, 1814) [36]

Download (289KB)
Indexing metadata
15. Fig. 14. Carl von Rokitansky (1804–1878) [37]

Download (136KB)
Indexing metadata
16. Fig. 15. Fetal heart at the 20th week of pregnancy. Patent ductus arteriosus (1) duct has a significant diameter, slightly inferior to the aorta (2) and pulmonary artery

Download (67KB)
Indexing metadata
17. Fig. 16. Fetal heart preparation. The pointer indicates an arterial duct with a width of 1.2 cm, a length of 2.6 cm

Download (139KB)
Indexing metadata

Copyright (c) 2023 Eco-Vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 69634 от 15.03.2021 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies