Unusual Presentation of Patent Ductus Arteriosus in Elderly Patient

Abstract

We presented a case of a 56-year-old man with giant pulmonary artery aneurysm caused by a misdiagnosed patent ductus arteriosus, severe multivalvular disease and active aortic valve endocarditis successfully treated by surgery. The correct diagnosis was missed despite preoperative diagnostics because the small patent ductus arteriosus was located at the distal part of common pulmonary trunk and a huge regurgitant signal overlapped its Doppler signal. Thorough evaluation of every patient, regardless of age, is necessary to recognize and treat this congenital anomaly.

Natural History of a Disease: Patent Ductus Arteriosus Diagnosed on an Elderly Woman

“…PDA is a rare disease in adults, which may present in a wide variety of signs and symptoms. The patient may be asymptomatic but has a continuous, systolic, and diastolic murmur heard at the upper left sternal border, also described as a “machinery murmur” [ 3 ]. As seen in this case, this patient was asymptomatic for 84 years, had not seen a provider for 40 years, and only had a diagnosis of “murmur during pregnancy.” The most common presentation in the elderly is heart failure, but pulmonary hypertension, atrial fibrillation, endocarditis, or pneumonia have been described [ 4 ].…”

“…Surgical closure remains the method of choice for the treatment of PDA, including traditional ligation or transcatheter closure [ 9 ]. Surgical techniques are influenced by factors, such as the size, shape, calcification, and friability of the PDA [ 3 ]. If large and complex forms of PDA are present, it may not be amenable for catheter closure, and surgical closure is warranted [ 7 , 10 ].…”

“…The mortality of untreated PDA in adults is 1.8% per year, with 34% of PDA patients dying before the age of 40 and 61% before the age of 60 [ 3 , 7 , 8 , 12 ].…”

A Case of Infective Endocarditis Associated With Patent Ductus Arteriosus in Which PET/CT Was Useful for Diagnosis

“…Mild cases of PDA may remain untreated, and the patient may live to term 5 . Unrecognized PDA in adults is still seen even in today's advanced medical world 4,6 . Individuals with congenital heart disease are at risk of developing IE, but those with PDA have a very low risk of IE (0.24/1000 per year) 7 .…”

“…5 Unrecognized PDA in adults is still seen even in today's advanced medical world. 4,6 Individuals with congenital heart disease are at risk of developing IE, but those with PDA have a very low risk of IE (0.24/1000 per year). 7 Patients with mild PDA can have a normal life span, even if untreated.…”