DETERMINATION OF THE HEMODYNAMIC SIGNIFICANCE OF "SILENT" FORMS OF THE PATENT DUCTUS ARTERIOSUS
Kulikova D.A.1,2, Krylova A.S.1, Safonova I.N.2
1SI "V.T. Zaycev Institute of General and Urgent Surgery AMS of Ukraine", Kharkiv
2Kharkiv Medical Academy of Postgraduate Education, Kharkiv
Relevance: The “silent form” of patent ductus arteriosus (PDA) is found in 20% of cases and presents as a condition in which diastolic blood flow to the pulmonary artery from the aorta is determined by ultrasound, but there appears to be no specific auscultation murmurs. To date, there remains a controversial question about the tactics of managing the patients with silent forms of PDA, determining the hemodynamic significance of the duct and the indications for the operative correction. Silent form of PDA occurs with a frequency of 0.065% among all newborns, in adulthood - 1 case per 500 people.
Objective: to determine the hemodynamic significance of silent forms of PDA.
Materials and methods: In SI "V.T. Zaycev Institute of General and Urgent Surgery AMS of Ukraine" between the years 2015 to 2018, 28 (100%) patients were observed with the silent form of the patent ductus arteriosus, aged from 1 month to 46 years. All patients underwent standard diagnostic procedures such as examination, chest X-ray, electrocardiography, ultrasound. The criteria for hemodynamic significance of PDA included: size of the PDA, signs of pulmonary overcirculation and significant shunt volume based on the percentage of blood flow in PA, which originated in the PDA. The first group includes 19 (67.8%) patients with patent ductus arteriosus who were asymptomatic and the duct did not have hemodynamic significance. The second group consisted of 9 (32.1%) patients with significant PDA who required surgical correction.
Results: 1) In the first group, 8 (28.5%) patients had a spontaneous duct closure. The remaining 11 patients (39.2%) we continue observing. 2) In the second group, 9 (32.1%) patients underwent surgical treatment. In the postoperative period, there was a positive trend - the absence of previous clinical picture and the normalization of ultrasound examination data.
Conclusions: The absence of specific auscultation murmurs does not exclude the presence of hemodynamic significant PDA. If at least three main criteria of hemodynamic significance and the percentage of blood flow in PA originating in the PDA is more than 10% it is recommended to consider surgical treatment.