Surgical Closure of the Patent Ductus Arteriosus.
نویسنده
چکیده
The patent ductus arteriosus was first described by Galen. No thought was given to the surgical treatment of patients with persistently patent ducti until 1907, when Munro described a technique for their ligation. It was not until twenty-one years later that Gross of Boston successfully ligated a patent ductus arteriosus for the first time. Since the epochal operation by Gross increased attention has been given to the surgical treatment of patent ductus arteriosus in America. The field has been further extended from that of a noninfected case to include surgical cure of cases of subacute "Streptococcus Viridans" endarteritis associated with patent ductus arteriosus. More recently additional cases of patent ductus arteriosus with other congenital heart disturbances which have been successfully treated surgically have been reported.-In fetal life the ductus arteriosus serves the important function of shunting blood from the pulmonic artery to the aorta thus by-passing the lungs. When the child is born, the lungs expand and the ductus normally closes. The blood in the pulmonary artery then passes through the lungs to be aerated. If the ductus fails to close the patient then possesses a persistently patent ductus arteriosus which is essentially an arteriovenous aneurysm. There is considerable difference of opinion as to the time in which a patent ductus arteriosus closes under normal conditions. According to Christi in a study of routine autopsy specimens from infants, at eight months only 2 per cent of the ducts remained open. Gross sets an arbitrary time limit of one year, believing that an open ductus after that time should be regarded as being abnormal. In discussing the etiology of a patent ductus arteriosus, Gross points out three interesting possibilities to be considered. Of these, the most important is the position and direction of the vessel. The ductus usually enters the aorta at an acute angle, and as the acuteness of the angle decreases, the ductus becomes more and more exposed to intra-aortic pressure. If the angle becomes a right, or even an obtuse angle, the force of intra-aortic pressure
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ورودعنوان ژورنال:
- Postgraduate medical journal
دوره 21 235 شماره
صفحات -
تاریخ انتشار 1945