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

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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.

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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

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Supplementary files

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1. Fig. 1. Blood circulation of the fetus (a) and newborn baby (b) [10]

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2. Fig. 2. Leonardo Botallo of Pavia, (1530–1600) [13]

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3. Fig. 3. Claudius Galen (131–199) [8]

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4. Fig. 4. William Harvey (1578–1657) [8]

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5. Fig. 5. Julius Cesare Aranzio of Bologna (1530–1589) [28]

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6. Fig. 6. Gabriele Fallopius of Padua (1523–1562) [28]

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7. Fig. 7. Hieronymus Fabricius of Padua (1537-1619) [8]

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8. 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]

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9. Fig. 9. Page of H. Fabricius’ book “The Foot Deformer”, 1600: title, page 27

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10. Fig. 10. Pages of H. Fabricius’ book “Deformato foutu”, 1600: page 23 and illustrations to it

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

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12. Fig. 12. John Richard Farre (1775–1862) [43]

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

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14. Fig. 14. Carl von Rokitansky (1804–1878) [37]

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15. 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

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16. Fig. 16. Fetal heart preparation. The pointer indicates an arterial duct with a width of 1.2 cm, a length of 2.6 cm

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