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Transcatheter closure of a calcified patent ductus arteriosus in an elderly man
J A Vita1, J A Bittl, A P Selwyn
1Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115.
Insights
Transcatheter closure effectively treated a calcified patent ductus arteriosus in an elderly patient. This minimally invasive approach offers a viable alternative for high-risk surgical candidates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Patent ductus arteriosus (PDA) can cause significant hemodynamic issues.
- Surgical closure of PDA carries high risks in elderly patients with comorbidities like severe lung disease.
- Calcification of the PDA further complicates surgical intervention.
Observation:
- A symptomatic 78-year-old male presented with a calcified PDA.
- Cardiac catheterization confirmed a left-to-right shunt with a pulmonary to systemic flow ratio of 2.8:1.
- The patient's severe lung disease and ductal calcification precluded surgical management.
Findings:
- Percutaneous transcatheter closure of the PDA was successfully performed using a 17 mm Rashkind double umbrella device.
- The device was deployed via the femoral vein.
- Post-closure, significant hemodynamic improvement was observed.
Implications:
- Transcatheter PDA closure is a safe and effective option for elderly patients deemed inoperable.
- This technique can lead to improved exercise tolerance and quality of life.
- Minimally invasive approaches expand treatment possibilities for complex cardiovascular conditions in older adults.
Abstract:
Successful transcatheter closure of a calcified patent ductus arteriosus was performed in a symptomatic 78 year old man. Cardiac catheterization revealed a left to right shunt across the patent ductus arteriosus with a pulmonary to systemic flow ratio of 2.8:1. Calcification of the ductus and severe lung disease increased the risk of surgical patent ductus arteriosus closure. A 17 mm Rashkind double umbrella was positioned in the ductus percutaneously by way of the femoral vein. After closure of the ductus there was marked hemodynamic improvement and the patient was discharged with improved exercise tolerance. Transcatheter closure of patent ductus arteriosus may be a viable option for the elderly patient too sick to withstand cardiovascular surgery.