Premature closure of the ductus arteriosus (PCDA) and transposition of the great arteries (TGA) cause persistent pulmonary hypertension of the newborn (PPHN). We present a case of a newborn who demonstrated d-TGA with ventricular septal defect (VSD) and pulmonary stenosis (PS) complicated by PCDA. The neonate showed severe cyanosis resistant to resuscitation soon after birth, and was diagnosed with d-TGA with VSD by echocardiography. PPHN was also suspected based on physical symptoms and results of echocardiography. The neonate was given inhaled nitric oxide, prostaglandin E1, and catecholamines under sedation, and underwent a balloon atrial septostomy (BAS). His condition gradually improved, and he was extubated on day 7, but his pulmonary subvalvular stenosis gradually worsened and pulmonary blood flow was markedly decreased. A second BAS was performed on day 27 and he showed no improvement. Blalock-Taussig shunt surgery was performed on day 34, which markedly improved his condition. The co-existence of d-TGA and PCDA is generally a lethal state. In our patient, an increase in pulmonary blood flow during the fetal period was restricted because of PS and outlet flow from the left ventricle to the right ventricle via the VSD. This restricted blood flow through the ductus arteriosus, which led to narrowing of the DA. At the same time, damage to and constrictive changes of the pulmonary vessels were prevented. The ductus arteriosus should be carefully evaluated to exclude PCDA in cases of d-TGA. The presence of both VSD and PS may be a prognostic factor in such cases.

译文

动脉导管过早闭合 (PCDA) 和大动脉转位 (TGA) 导致新生儿持续性肺动脉高压 (PPHN)。我们介绍了一例新生儿,该新生儿表现出d-tga伴室间隔缺损 (VSD) 和肺动脉狭窄 (PS) 并发PCDA。新生儿出生后不久就表现出严重的紫绀抵抗复苏,并通过超声心动图诊断为d-TGA和VSD。根据身体症状和超声心动图检查结果,也怀疑PPHN。新生儿在镇静下吸入一氧化氮,前列腺素E1和儿茶酚胺,并接受球囊房间隔造口术 (BAS)。病情逐渐好转,第7天拔管,但肺瓣膜下狭窄逐渐加重,肺血流量明显减少。在第27天进行了第二次BAS,但他没有任何改善。在第34天进行了Blalock-Taussig分流手术,明显改善了他的病情。d-TGA和PCDA的共存一般是致死状态。在我们的患者中,由于PS和通过VSD从左心室到右心室的出口流,限制了胎儿期间肺血流量的增加。这种通过动脉导管的血流受限,导致DA变窄。同时,防止了肺血管的损伤和收缩变化。在d-tga的情况下,应仔细评估动脉导管以排除PCDA。在这种情况下,VSD和PS的存在可能是预后因素。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录