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