Endovascular Stent-Graft Exclusion of Adult Giant Patent Ductus Arteriosus Through a Hybrid Transabdominal Approach

Rationale:Patent ductus arteriosus (PDA) ligation by open surgery is more difficult and dangerous in elderly patients than in infants. Nowadays, simple and safe interventional catheterization technology is used for the closure of uncomplicated isolated PDAs. Therefore, an alternative less invasive therapeutic option must be developed to treat complicated PDA.Patient concerns:A 53-year-old woman presented with gradually exacerbated dyspnea on effort and continuous cardiac murmurs.Diagnosis:Transthoracic echocardiography (TTE) and contrast-enhanced 3D computed tomography (CT) were performed and revealed a conically shaped large PDA with calcification.Interventions:We used a nontouch exclusion technique with thoracic endovascular repair (TEVAR) for the treatment of this rare complicated PDA. The patient had an adequate proximal landing zone, and a tapered stent graft (S&G, Bio 34–30 mm × 110 mm, Korea) was used.Outcomes:Aortography after stent graft implantation revealed complete occlusion of PDA and no endoleaks. The procedure was successful, and the patient showed no vascular or other complications during follow-up.Lessons:TEVAR is a less invasive solution for pathologies of the thoracic aorta, such as aortic dissection or aneurysm. TEVAR is an established, simple, and safe method for repairing the thoracic aorta and can be a new alternative to other transcatheter techniques for complicated PDAs in elderly patients.

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“…Some studies reported the successful closure of calcified PDA using TEVAR with only a few complications in elderly patients. [8,9]…”

Section: Discussionmentioning

confidence: 99%

Thoracic endovascular repair technique for the treatment of patent ductus arteriosus in an elderly patient

Kim

Baek

2018

Medicine

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“…Several recent studies described patients treated by arterial duct closure with a stent graft. [8][9][10] In the future, the low profile of a stent graft delivery system may lead to increase in the number of patients undergoing TEVAR for PDA in adults. On the other hand, concerns have also been expressed over TEVAR.…”

Section: Discussionmentioning

confidence: 99%

A Case of Patent Ductus Arteriosus in an Elderly Patient Treated by Thoracic Endovascular Aortic Repair

Orimoto

Ishibashi

Sugimoto

et al. 2016

Annals of Vascular Diseases

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The patient described herein was a 75-year-old female. Echocardiography showed patent ductus arteriosus (PDA). Heart failure symptoms gradually appeared, and she was referred to our department for treatment. Contrast-enhanced computed tomography (CT) revealed a tubular structure communicating between the aortic arch and pulmonary artery trunk, suggesting adult PDA. Thoracic endovascular aortic repair (TEVAR) was performed to close PDA. Completion angiography confirmed the disappearance of PDA. Post-TEVAR CT revealed no endoleak. The patient was discharged from the hospital on the 11th day after surgery. TEVAR is more useful and less invasive for adult PDA than conventional open surgery. Keywords: patent ductus arteriosus (PDA), thoracic endovascular aortic repair (TEVAR)thoracic endovascular aortic repair (TEVAR) for PDA in an elderly patient. Case ReportA 75-year-old female consulted a local clinic with cold symptoms. Tachycardia and cardiac murmurs were detected, and echocardiography showed PDA. Heart failure symptoms gradually became exacerbated, and she was referred to our hospital. Her height and body weight were 149 cm and 52.5 kg, respectively. Continuous murmurs were heard in the thoracic region. Chest X-ray revealed a protrusion in the left second arch (pulmonary artery trunk) and the enhancement of a pulmonary vascular shadow. The cardio-thoracic ratio (CTR) was 66%. Electrocardiography did not show any abnormal findings. Echocardiography revealed PDA with a diameter of 8 mm and high shunt flow (Vmax: 600 cm/sec). Dilatation of the left ventricle and atrium suggesting left heart loading was observed. Right heart catheterization revealed a leftto-right shunt with an increase in pulmonary arterial pressure. The pulmonary to systemic blood flow ratio (Qp/Qs) was 2.1. On saturation, O2 step-up of the pulmonary artery was observed. Contrast-enhanced computed tomography (CT) revealed an arterial duct communicating between the aortic arch and pulmonary artery that measured 14 mm in diameter (Fig. 1a). The pulmonary artery trunk measured 55 mm and showed marked dilatation involving the left and right pulmonary arteries (Fig. 1b). The distance between the left subclavian artery and arterial duct was 20 mm. The aortic diameter at a tributary of the subclavian artery was 27 mm, and that of the thoracic descending aorta was 25 mm (Fig. 2). Arterial-duct closure by the placement of a stent graft at zone 3 was considered possible. Surgery was performed under general anesthesia. A pigtail catheter was inserted from the left brachial artery, and digital subtraction angiography (DSA) was performed. Blood flow from the aorta to the pulmonary artery was clearly confirmed. TEVAR using CTAG 31 mm-15 cm

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“…in the case of a small adult patient in whom the femoral vessels were not large enough to accommodate stent graft insertion, there is a report of a laparotomy and end-to-side anastomosis of a dacron graft to the abdominal aorta performed to form a conduit for stent graft implantation. 36 in another report, the dilated pda was closed by patch repair from the pa side accompanied by a multiple valve surgery, after which the aorta-side entry of the aneurysmal pda was covered with an endovascular stent graft. 37 there have been reports of hybrid approaches to coarctation of the aorta stenting, specifically in settings where the coarctation is diagnosed late in life in conjunction with other cardiac abnormalities, 38 or when an aberrant right subclavian artery was present; in these cases, hybrid vascular surgery to reimplant the head and neck vessels has allowed covered stent implantation.…”

Section: Hybrid Procedures In Adults With Congenital Heart Diseasementioning

confidence: 99%

Hybrid Interventional Procedures in Congenital Heart Disease

Holoshitz¹,

Kenny²,

Hijazi

2014

Methodist DeBakey Cardiovascular Journal

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The evolution of congenital cardiac surgery has seen significant innovative advances in collaborative efforts between congenital cardiac surgeons and interventionalists to provide the least invasive intervention with the greatest hemodynamic benefit for patients with congenital heart disease. This review looks at how this collaborative approach has evolved and is being applied to treat a number of congenital conditions across the age ranges.

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Endovascular Stent-Graft Exclusion of Adult Giant Patent Ductus Arteriosus Through a Hybrid Transabdominal Approach

Cited by 6 publications

References 7 publications

Thoracic endovascular repair technique for the treatment of patent ductus arteriosus in an elderly patient

Thoracic endovascular repair technique for the treatment of patent ductus arteriosus in an elderly patient

A Case of Patent Ductus Arteriosus in an Elderly Patient Treated by Thoracic Endovascular Aortic Repair

Hybrid Interventional Procedures in Congenital Heart Disease

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