Transcatheter Closure of a Patent Ductus Arteriosus with Healed Vegetation: A Case Report

Abstract

Background: The unrepaired patent ductus arteriosus (PDA) is at risk for congestive heart failure (CHF) and/or infective endocarditis (IE). Transcatheter closure of PDAs with occluder devices has been advanced to be the strategy of choice for managing anatomically feasible PDAs. Despite it is not clear if the closure of a small PDA is beneficial, routine closure of any PDA in children and young adults appeared reasonable to decrease the risk of IE. Case report:We report on a one-year and two-month-old boy who had a small Krichenko type D PDA, with two constrictions at its middle part and its pulmonary end, and with healed vegetation within the PDA. We successfully closed the PDA percutaneously using a 5x4 mm Nit-Occlud® PDA coil (PFM medical, Köln, Germany) with an unremarkable 2-year follow-up. To our knowledge, this is the first reported case of a PDA with a previous IE and healed vegetation within the duct that was closed by the transcatheter approach. Conclusion: Closure of PDAs is indicated in patients with left ventricular overload or with continuous murmurs. Despite it is not clear if the closure of small PDAs is beneficial, routine closure of any PDA in children and young adults appeared reasonable to decrease the risk of IE. A history of previous IE makes PDA closure mandatory. Differentiation between IE recurrence and the persistence of healed vegetation from a previously treated IE can be difficult.