胎生期動脈管の薬理学(東京女子医科大学学会第66回総会特集)

概要

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Fetal ductus arteriosus is widely patent, permitting 90% of right ventricular output flowing to the descending aorta in the fetus. Until 1990, only low pO_2 and prostaglandins were known as factors which maintain dilatation of fetal ductus arteriosus. Only recently, other factors which control fetal ductal tone have been discovered. Nitric oxide is the important factor which maintains patency of the fetal ductus. The major role of nitric oxide is to maintain ductal patency in mid-gestation, when prostaglandins is not working. In late gestation, the role of nitric oxide in maintaining fetal ductal patency switches to prostaglandins. Prostaglandins are produced by cyclooxygenase (COX) 1 and 2. COX-2 is important in maintaining ductal patency, and therapeutic use of selective COX-2 inhibitors in closing patent ductus arteriosus in premature baby is recommended. Vitamin A increases sensitivity of ductal sensitivity to oxygen and ductal constriction by indomethacin. Endothelin is essential in fetal ductal constriction, and pharmacological fetal ductal constriction is completely prevented by endothelin blockers such as Bosentan.
東京女子医科大学の論文
2001-04-25