WordNet

a continuous tube formed by a row of elongated cells lacking intervening end walls
an enclosed conduit for a fluid
a bodily passage or tube lined with epithelial cells and conveying a secretion or other substance; "the tear duct was obstructed"; "the alimentary canal"; "poison is released through a channel in the snakes fangs" (同)epithelial duct, canal, channel

PrepTutorEJDIC

送水管;(建物・船などの)通気管;(地下ケーブルなどの)ダクト / (体液を運ぶ)導管,(植物が水・空気を運ぶ)導管

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/06/07 17:03:16」(JST)

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In the developing fetus, the ductus arteriosus, also called the ductus Botalli, is a blood vessel connecting the pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus's fluid-filled non-functioning lungs. Upon closure at birth, it becomes the ligamentum arteriosum. There are two other fetal shunts, the ductus venosus and the foramen ovale.

Structure

The ductus arteriosus attaches to the final part of the arch of aorta (the isthmus of aorta) and the first part of the [pulmonary artery]^[1]

Clinical significance

Patent ductus arteriosus

Failure of the DA to close after birth results in a condition called patent ductus arteriosus and the generation of a left-to-right shunt. If left uncorrected, patency leads to pulmonary hypertension and possibly congestive heart failure and cardiac arrhythmias.

The E series of prostaglandins are responsible for maintaining the patency of the DA (by dilation of vascular smooth muscle) throughout the fetal period.^[2] Prostaglandin E2 (PGE₂), produced by both the placenta and the DA itself, is the most potent of the E prostaglandins, but prostaglandin E1 (PGE₁) also has a role in keeping the DA open.^[3] PGE₁ and PGE₂ keep the DA open via involvement of specific PGE-sensitive receptors (such as EP2 or EP4).^[4] EP4 is the major receptor associated with PGE₂-induced dilation of the DA and can be found across the DA in smooth muscle cells.^[5] Immediately after birth, the levels of both PGE₂ and the EP4 receptors reduce significantly, allowing for closure of the DA and establishment of normal postnatal circulation.^[5]

In some types of congenital heart defect (e.g., transposition of the great arteries), prostaglandins may be administered to maintain DA patency, allowing for the continual circulation and oxygenation of blood, until surgery can be performed.^[6]

DA closure may be induced by administration of nonsteroidal anti-inflammatory drugs (NSAIDs), which inhibit prostaglandin production.^[3] The most common NSAID that is used to force DA closure is Indomethacin, which can be administered after birth.^[3] By inhibiting PGE₂ formation, EP4 receptor activation will decrease and normal circulation can begin. NSAIDs taken late in pregnancy can cross the placenta and lead to premature closure of the DA in the fetus.^[7] In this case, exogenous PDE₂ can be administered to reverse the effects of the NSAIDs and maintain the patency of the DA for the remainder of the pregnancy.^[3]

A patent ductus arteriosus affects approximately 4% of infants with Down syndrome (DS). A failure to thrive is a very common sign of this condition.^[8]

References

^ Srichai, editors, David P. Naidich ... [et al.] ; contributing author, Monvadi B. (2007). Computed tomography and magnetic resonance of the thorax (4th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. p. 100. ISBN 9780781757652.
^ Lucas, A (1978). "PROSTAGLANDINS IN PATENT DUCTUS ARTERIOSUS". The Lancet 312 (8096): 937–938. doi:10.1016/S0140-6736(78)91648-3. ISSN 0140-6736.
^ ^a ^b ^c ^d Olley, P.M.; Conceani F. (1981). "Prostaglandins and the Ductus Arteriosus". Annual Review of Medicine 32 (1): 375–385. doi:10.1146/annurev.me.32.020181.002111.
^ Bouayad A, Kajino H, Waleh N, Fouron JC, Andelfinger G, Varma DR, Skoll A, Vazquez A, Gobeil F, Clyman RI, Chemtob S (2001). "Characterization of PGE2 receptors in fetal and newborn lamb ductus arteriosus". Am. J. Physiol. Heart Circ. Physiol. 280 (5): H2342–9. PMID 11299240.
^ ^a ^b Gruzdeva, A; Nguyena, M.; Kovarovob, M.; Koller, B (March 2012). "PGE2 through the EP4 receptor controls smooth muscle gene expression patterns in the ductus arteriosus critical for remodeling at birth.". Prostaglandins and other Lipid Mediators 94 (3): 109–119. doi:10.1016/j.prostaglandins.2012.02.001.
^ "Congenital heart defects: Prostaglandins and prostaglandin inhibitors.". Healthwise. My Health Alberta.
^ Anonucci, R; Zaffanello, M.; Puxeddu, E.; Porcella, A.; Cuzzolin, L.; Pilloni, M.; Fanos, V. (2012). "Use of non-steroidal anti-inflammatory drugs in pregnancy:impact on the fetus and newborn". Current Drug Metabolism 13 (4): 474–490. doi:10.2174/138920012800166607.
^ Pritchard & Korf. "Medical Genetics at a Glance". Blackwell Publishing. 2010. p63.

External links

Circulatory changes at birth at berkeley.edu

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 動脈管開存症の臨床症状および診断 clinical manifestations and diagnosis of patent ductus arteriosus
2. 動脈管開存症の管理 management of patent ductus arteriosus
3. 早産児における動脈管開存症の病態生理、臨床症状、および診断 pathophysiology clinical manifestations and diagnosis of patent ductus arteriosus in premature infants
4. 早産児における動脈管開存症の管理 management of patent ductus arteriosus in premature infants
5. 乳幼児および小児における心不全の病因および診断 etiology and diagnosis of heart failure in infants and children

English Journal

Neonatal side effects of maternal labetalol treatment in severe preeclampsia.

Heida KY, Zeeman GG, Van Veen TR, Hulzebos CV.SourceDepartment of Obstetrics and Gynecology, University Medical Center Groningen, The Netherlands.
Early human development.Early Hum Dev.2012 Jul;88(7):503-7. Epub 2012 Apr 22.
OBJECTIVE: Labetalol is often used in severe preeclampsia (PE). Hypotension, bradycardia and hypoglycemia are feared neonatal side effects, but may also occur in (preterm) infants regardless of labetalol exposure. We analyzed the possible association between intrauterine labetalol exposure and such
PMID 22525036

Bronchodilators for the prevention and treatment of chronic lung disease in preterm infants.

Ng G, da Silva O, Ohlsson A.SourceDivision of Neonatology, Imperial College Healthcare NHS Trust, St. Mary's Hospital, Room 11, 4th Floor Salton House, Praed Street, London, UK, W2 1NY.
Cochrane database of systematic reviews (Online).Cochrane Database Syst Rev.2012 Jun 13;6:CD003214.
BACKGROUND: Chronic lung disease (CLD) occurs frequently in preterm infants. Bronchodilators have the potential effect of dilating small airways with muscle hypertrophy. Increase in compliance and tidal volume and decrease in pulmonary resistance have been documented with use of bronchodilators in s
PMID 22696334

Japanese Journal

Transcription Profiles of the Ductus Arteriosus in Brown-Norway Rats With Irregular Elastic Fiber Formation

Hsieh Yi-Ting,Liu Norika Mengchia,Ohmori Eriko [他]
Circulation journal : official journal of the Japanese Circulation Society 78(5), 1224-1233, 2014-05
NAID 40020045560

症例胎児動脈管早期閉鎖および肺動脈弁欠損症を合併したFallot四徴症の1例

田中健太郎,藤田太輔,佐野匠 [他]
産科と婦人科 81(3), 399-402, 2014-03
NAID 40019991341

先天性心疾患におけるカテーテル治療の最前線 (特集先天性心疾患および小児心疾患医療の最前線)

上岡亮,赤木禎治
循環器内科 75(1), 59-66, 2014-01
NAID 40019956412

Related Pictures

★リンクテーブル★

リンク元	「動脈管」「動脈管索」
拡張検索	「delayed closure of ductus arteriosus」「patent ductus arteriosus due to prematurity」
関連記事	「duct」「ductus」「arteriosus」

「動脈管」

Ductus arteriosus
	Plan of the fetal circulation. ("Ductus arteriosus" visible at upper right.)
	Heart cross-section with PDA
Details
Precursor	aortic arch 6
Source	pulmonary artery
Branches	descending aorta
Vein	ductus venosus
Identifiers
Latin	Ductus arteriosus
MeSH	A07.541.278.395
Dorlands; /Elsevier	d_29/12314749
TE	E5.11.2.1.2.0.17
FMA	79871
	Anatomical terminology; [edit on Wikidata]

　　[★]

英: arterial duct
ラ: ductus arteriosus
同: Botallo's duct Botallo duct Botallo管ボタロ管ボタロー管ボタロー動脈管
関: 卵円孔、胎児循環

[show details]

ボタロ管 : 約 82 件
ボタロー管 : 約 5,630 件

血行動態

右室(上半身由来の血液)から駆出された血液は10%程度が肺動脈へ、残りは大動脈に流入する。

閉鎖時期

生後1-2日/2-3日(QB.P-192)
生後半日で閉鎖し、器質的閉鎖は数日後である。(G10M.29)

動脈管閉鎖の原因

血中酸素分圧の上昇
プロスタグランジンの減少。(PGEの減少)

臨床関連

動脈管開存症

Henry Gray (1825-1861). Anatomy of the Human Body. 1918.

「動脈管索」

　　[★]

英: ligamentum arteriosum (N,KL,KH,M,L), arterial ligament (Z)
同: ボタロー靭帯 Botallo ligament
関: 心臓、ボタロー管 Botallo's duct、動脈管 ductus arteriosus、ボタロー動脈管 ductus arteriosus Botalli

胎児期の動脈管の遺残