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Abstract(s)
O canal arterial é uma estrutura vascular que une a artéria aorta descendente ao
segmento superior do tronco da artéria pulmonar, perto da origem da artéria pulmonar
esquerda. Ă uma estrutura essencial Ă vida fetal intrauterina e que fecha espontaneamente
apĂłs o nascimento. ApĂłs as primeiras semanas de vida, a persistĂȘncia do canal arterial Ă©
considerada anormal, constituindo uma das cardiopatias congĂ©nitas com maior incidĂȘncia nos
recém-nascidos prematuros, estando também presente nos recém-nascidos de termo.
SĂŁo fatores que promovem o relaxamento muscular, e portanto mantĂȘm o canal
arterial permeĂĄvel, as prostaglandinas, o Ăłxido nĂtrico e a bradicinina. Por outro lado, fatores
como oxigénio, altas doses de bradicinina e o sistema nervoso autónomo promovem a
constrição da camada muscular. Existem algumas alteraçÔes genĂ©ticas que se associam Ă
maior probabilidade de persistĂȘncia do canal arterial, assim como fatores ambientais.
O meio de diagnĂłstico mais sensĂvel para a persistĂȘncia do canal arterial Ă© a
ecocardiografia, sendo possĂvel a realização de tomografia computorizada e ecografia
intravascular para melhor caracterização da estrutura do canal arterial.
Clinicamente, a persistĂȘncia do canal arterial, pode ser assintomĂĄtica ou ter
consequĂȘncias graves associadas como hipertensĂŁo pulmonar.
O encerramento do canal arterial estĂĄ recomendado em pacientes sintomĂĄticos que
apresentem um shunt esquerdo-direito significativo, que tenham sinais de dilatação auricular
ou ventricular esquerda e ainda nos casos em que se verifique hipertensĂŁo pulmonar
reversĂvel. Em pacientes com hipertensĂŁo pulmonar irreversĂvel nĂŁo estĂĄ recomendado o
encerramento do canal arterial. Quando o canal arterial persistente Ă© pequeno ou silencioso
sem um shunt esquerdo-direito significativo, a decisĂŁo de encerrar ainda nĂŁo Ă© clara e
consensual.
Para o seu encerramento podem utilizar-se os inibidores das cicloxigenases como a
indometacina, o ibuprofeno e o paracetamol. Para o encerramento percutĂąneo existem vĂĄrios
dispositivos que tĂȘm vindo a evoluir de modo a reduzir cada vez mais as complicaçÔes
associadas, sendo considerada uma alternativa com bons resultados nesta patologia. A opção
de encerramento cirĂșrgico reserva-se para os casos em que a terapĂȘutica mĂ©dica se tenha
revelado ineficaz ou em situaçÔes selecionadas clinicamente.
The ductus arteriosus is a vascular structure that connects the descending aorta to the top of the pulmonary trunk, near the left pulmonary artery origin. It is an essential structure for intrauterine fetal life which closes spontaneously after birth. After the first few weeks of life, patency of the ductus arteriosus is considered abnormal, constituting one of the congenital heart diseases with a higher incidence in premature infants and also in term newborns. Factors that promote muscle relaxation, and thus maintain a patent ductus arteriosus, are prostaglandins, nitric oxide and bradykinin. Other metabolic agents such as oxygen, high doses of bradykinin and the autonomic nervous system promote the constriction of the muscle layer. There are, also, a few genetic changes that are associated with greater likelihood of patent ductus arteriosus, as well as environmental factors. The most sensitive diagnostic method for patent ductus arteriosus is echocardiography, but it is also possible to perform computed tomography and intravascular ultrasound to better characterize the ductus arteriosus structure. Clinically, patent ductus arteriosus, may be asymptomatic or, on the contrary, present itself with serious consequences, such as pulmonary hypertension. The closure of the ductus arteriosus is recommended in symptomatic patients who have a significant left-right shunt, which have signs of left atrial or ventricular dilation and even in cases where there is reversible pulmonary hypertension. In patients with irreversible pulmonary hypertension the closure of the ductus arteriosus is not recommended. When the patent ductus arteriosus is small or silent without a significant left-right shunt, the decision to close is not yet clear cut and consensual. For the ductus arteriosus closure, inhibitors of cycloxygenase, such as indomethacin, ibuprofen and acetaminophen can be used. For percutaneous closure there are several devices that have evolved to reduce associated complications and this is considered an effective alternative for this clinical entity. The surgical ligation option is reserved for cases where medical therapy was deemed ineffective or in selected clinical situations.
The ductus arteriosus is a vascular structure that connects the descending aorta to the top of the pulmonary trunk, near the left pulmonary artery origin. It is an essential structure for intrauterine fetal life which closes spontaneously after birth. After the first few weeks of life, patency of the ductus arteriosus is considered abnormal, constituting one of the congenital heart diseases with a higher incidence in premature infants and also in term newborns. Factors that promote muscle relaxation, and thus maintain a patent ductus arteriosus, are prostaglandins, nitric oxide and bradykinin. Other metabolic agents such as oxygen, high doses of bradykinin and the autonomic nervous system promote the constriction of the muscle layer. There are, also, a few genetic changes that are associated with greater likelihood of patent ductus arteriosus, as well as environmental factors. The most sensitive diagnostic method for patent ductus arteriosus is echocardiography, but it is also possible to perform computed tomography and intravascular ultrasound to better characterize the ductus arteriosus structure. Clinically, patent ductus arteriosus, may be asymptomatic or, on the contrary, present itself with serious consequences, such as pulmonary hypertension. The closure of the ductus arteriosus is recommended in symptomatic patients who have a significant left-right shunt, which have signs of left atrial or ventricular dilation and even in cases where there is reversible pulmonary hypertension. In patients with irreversible pulmonary hypertension the closure of the ductus arteriosus is not recommended. When the patent ductus arteriosus is small or silent without a significant left-right shunt, the decision to close is not yet clear cut and consensual. For the ductus arteriosus closure, inhibitors of cycloxygenase, such as indomethacin, ibuprofen and acetaminophen can be used. For percutaneous closure there are several devices that have evolved to reduce associated complications and this is considered an effective alternative for this clinical entity. The surgical ligation option is reserved for cases where medical therapy was deemed ineffective or in selected clinical situations.
Description
Keywords
Canal Arterial Persistente Cirurgia CardĂaca Ibuprofeno Indometacina Tratamento PercutĂąneo