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Transcatheter Folded Valve Placement Within a Patent Ductus Arteriosus for Pulmonary Hypertension
Eli S Fredman1, Hadeel Allam1, Nidhy P Varghese2
1Division of Pediatric Cardiology, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri, USA.
Background:
Severe pulmonary arterial hypertension (PAH) with bidirectional patent ductus arteriosus (PDA) presents a challenge, as ductal closure is contraindicated.
Case Summary:
A 14-year-old boy with severe PAH and bidirectional PDA experienced exercise intolerance. He underwent transcatheter placement of a 20-mm folded Melody valve within the native PDA. The procedure eliminated diastolic left-to-right shunting while preserving systolic right-to-left shunting. At 1-year follow-up, he demonstrated durable unidirectional shunting and improved to NYHA functional class I status.
Discussion:
While surgical valved reverse Potts shunts exist in the literature, adapting a transcatheter valve to create a unidirectional shunt within the native PDA percutaneously is novel. It offers a less invasive alternative for managing suprasystemic PAH.
Take-Home Messages:
Transcatheter folded valve placement within a native PDA safely establishes a unidirectional right-to-left shunt. This intervention reduces pulmonary overcirculation while maintaining vital ventricular decompression.
