Background Hemolysis after Patent ductus arteriosus (PDA) device closure is rare. Although in most cases, hemolysis settles on its own; however, in some cases it may not settle spontaneously and may require additional procedures like putting additional coils, gel foam or thrombin instillation, balloon occlusion, or removing it surgically. We report a case of adult PDA device closure who persisted with hemolysis and was managed by transcatheter retrieval. Case presentation A 52-year-old gentleman presented to us with a diagnosis of large PDA with operable hemodynamics. Descending thoracic aortic Angio showed a large 11 mm PDA. Transcatheter device closure was done in the same sitting with a 16 × 14 Amplatzer Ductal Occluder I(ADO) device,;however, after device release, the aortic end of the device was not fully formed and there was residual flow. The next morning patient started with gross hematuria with persistent residual flow. We tried to manage with conservative means including hydration, and blood transfusion; however, residual flow persisted for 10 days and his hemoglobin dropped from 13 gm/dl preprocedural to 7 gm/dl, creatinine increased from 0.5 mg/dl to 1.9 mg/dl, bilirubin increased to 3.5 mg/dl & urine showed hemoglobinuria. As the patient continued to deteriorate it was planned to retrieve the device by transcatheter approach. 10 French amplatzer sheath was parked in the pulmonary artery near the ductus. We tried with a combination of multiple catheters and Gooseneck snare (10 mm) and finally, we successfully retrieved with a combination of Multipurpose (MP) catheter and 10 mm Gooseneck snare. After that, we closed the defect successfully with a double disk device (muscular Ventricular septal defect 14 mm Amplatzer). The patient’s hematuria settled and was discharged after 2 days with normal hemoglobin and creatinine. Conclusions Patent ductus arteriosus ADO 1 device should not be released if the aortic end of the disk is not fully formed Patient should be carefully monitored for hemolysis if evidence of residual shunt and given supportive treatment. If conservative treatment fails, residual flow needs to be eliminated. Transcatheter retrieval although technically challenging is a feasible treatment. A muscular VSD device is a good alternative to the usual PDA device to close PDA, especially in adults.

Background: Signicant coronary artery lesions can be detected by evaluating regional myocardial perfusion by Cardiac MRI (CMR). This study aims to determine the usefulness of this technique in “known” patients of coronary artery disease (CAD). Our study aims at describing CMR featur Methods: es of CAD, including CINE and perfusion imaging. Stress perfusion imaging with pharmacologic stress (Adenosine) was performed on 22 patients with known CAD. These patients also underwent Catheter angiography (CAG). A total of 66 coronary territories were assessed for perfusion abnormalities and corresponding CAG ndings. Regional wall motion abnormalities were Results: seen in 28(42.4%) coronary territories and regional myocardial thinning in 11(16%) territories. Hypokinesia (68%) was the most commonly observed wall motion abnormality. Wall motion abnormality was present in most (91%; n=20) of the infarcted territories and some (18.2%;n=8) of the non-infarct territories. Regional myocardial thinning was present in some of the infarcted (27%; n=6) territories and none of the non-infarcted territories. The mean wall thickness in infarct territories was 5.1mm±0.4 and in non-infarct territories was 7.1mm±0.6. T2/STIR hyperintensity was present in 5 (23%) infarct related coronary territories and none of the non-infarcted territories. In all 5 cases, MRI was done within 10 days of symptom onset. 32 (49%) coronary territories showed perfusion defect on stress imaging, with 23 (35%) of them showing a matched defect on rest perfusion and 9 (14%) showing stress inducible perfusion defect. No perfusion defect was seen in 34(51%) territories. All 22 patients underwent CAG. 15patients had signicant disease (>70%) in a single vessel, 5 had in two vessels and none had in all the three vessels.2 patients had non-occlusive coronaries (MINOCA). Using CAG as gold standard, the sensitivity of stress perfusion CMR in detecting signicant CAD in non-infarct territory in these patients was 70%, with a specicity of 94% and accuracy of 88.3%. Visual analysis of rst-pass gadolinium CMR perfusion images to detect reg Conclusion: ional myocardial perfusion defect has a moderate sensitivity and high specicity for diagnosing signicant obstructive CAD in non-infarct related coronaries, as compared to CAG.