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Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
Published on: December 23, 2022
Extrinsic bronchial compression due to patent ductus arteriosus closure device
Gerard J Fitzmaurice1, David M Coleman, Kevin P Walsh
1Department of Cardiothoracic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland. gfitzmaurice@doctors.org.uk
The Annals of Thoracic Surgery
|May 28, 2013
Summary
Device closure for patent ductus arteriosus (PDA) in infants with a right-sided aortic arch can lead to severe bronchomalacia. Surgical closure or softer devices may be safer alternatives for this specific anatomy.
Area of Science:
- Interventional Cardiology
- Congenital Heart Disease
- Pediatric Cardiac Surgery
Background:
- Patent ductus arteriosus (PDA) is commonly managed nonoperatively using device closure in interventional cardiology.
- Congenital heart disease, including PDA, requires careful consideration of anatomical variations for optimal treatment.
- Right-sided aortic arch is a rare congenital anomaly that can alter the relationship between mediastinal structures.
Observation:
- A patient with a right-sided aortic arch and PDA presented with severe bronchomalacia following transcatheter device closure.
- The PDA in this case inserted into the right pulmonary artery, a critical anatomical feature.
- The bronchomalacia necessitated significant surgical intervention, highlighting a potential complication.
Findings:
- Device closure of PDA in the context of a right-sided aortic arch and right pulmonary artery insertion poses a risk of bronchial compression.
- This compression can lead to the development of severe bronchomalacia, a serious airway condition.
- The anatomical configuration increases the technical challenge and risk profile for device closure.
Implications:
- Interventional cardiologists should exercise caution when considering device closure for PDA in infants with a right-sided aortic arch and right pulmonary artery insertion.
- Surgical closure should be strongly considered as a primary treatment option in such cases.
- The use of alternative, potentially softer, duct occlusion devices might mitigate the risk of bronchial compression and subsequent bronchomalacia.
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