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Temporary Occlusion of Patent Ductus Arteriosus in Adult during Cardiac Surgery
Koki Ikemoto1, Wataru Nakayama1, Katsuhiko Oka1
1Department of Cardiovascular Surgery, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Kyoto, Japan.
Insights
This case study shows temporary occlusion of patent ductus arteriosus during cardiac surgery can successfully treat infective endocarditis in adults. This approach offers a viable option for complex cases.
Area of Science:
- Cardiology
- Cardiac Surgery
- Infectious Diseases
Background:
- Patent ductus arteriosus in adults is rare and typically requires closure due to cardiac complication risks.
- Closure methods like endovascular devices or patches are controversial in active infections.
- Infective endocarditis presents significant surgical challenges, especially with coexisting conditions.
Introduction:
Patent ductus arteriosus in adults is rare, and is commonly recommended to be closed due to the possibility of cardiac complications. Patent ductus arteriosus closure has been often performed using endovascular devices or patches. However, the use of these closure devices in the presence of active infection is controversial, and patch closure procedure along with other cardiac surgery could make it more complicated. We report a case in which we successfully treated infective endocarditis with temporary occlusion of a patent ductus arteriosus in an 80-year-old woman.
Case Presentation:
An 80-year-old woman with a medical history of total left hip arthroplasty, patent ductus arteriosus, and mild aortic, mitral, and tricuspid valve regurgitation was admitted to another hospital with recent symptoms of general fatigue and lower limb edema. Laboratory blood tests revealed elevated C-reactive protein levels and white blood cell counts. CT revealed fluid accumulation around the left artificial hip joint and multiple embolisms in the lungs and kidneys. MRI revealed microbleeds in the brain. Transthoracic echocardiography revealed severe aortic regurgitation and large vegetations on both the aortic and mitral valves. Streptococcus sanguinis was detected by both blood and fluid culture examinations. She was transferred to our hospital for surgical treatment under the diagnosis of infective endocarditis. Aortic and mitral valve replacement with cardiopulmonary bypass was scheduled; however, preoperative and intraoperative closure of the patent ductus arteriosus was not planned considering potential risks. A percutaneous balloon catheter was placed in the pulmonary artery through the patent ductus arteriosus, and temporary occlusion was achieved. During the aortic and mitral valve replacement procedure, blood flow from the pulmonary vein was well controlled. After cardiopulmonary bypass was weaned off, the balloon was deflated and removed. The postoperative course was uneventful, and the patient was transferred to another hospital for further rehabilitation.
Conclusions:
The successful outcome of the present case shows that temporary occlusion of the patent ductus arteriosus during cardiac surgery with cardiopulmonary bypass may be a useful treatment option for patients with patent ductus arteriosus and infective endocarditis.
