Related Experiment Video
Updated: Jul 12, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Immediate Zero-Contrast Ductal Closure Following Emergent Valvotomy in Pulmonary Atresia With Intact Ventricular
Brian Mendel1, Hannah Soetjoadi2, Radityo Prakoso3
1Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia.
Background:
The timing of patent ductus arteriosus (PDA) closure after valvotomy in pulmonary atresia with intact ventricular septum (PA-IVS) remains controversial.
Case Summary:
A 23-day-old neonate with PA-IVS and tripartite right ventricle underwent valvotomy. Immediate PDA closure was subsequently performed because systemic diastolic pressure remained low despite adequate antegrade pulmonary flow, suggesting clinically significant ductal runoff with risk of systemic hypoperfusion. Given the patient's impaired renal function, the PDA closure was conducted using zero-contrast technique under minimal fluoroscopic guidance.
Discussion:
Concomitant valvotomy and PDA closure may be considered in selected PA-IVS patients when antegrade pulmonary flow is adequate but ductus arteriosus remains hemodynamically significant.
Take-Home Message:
Timing of ductal occlusion in PA-IVS requires individualized hemodynamic judgment, with zero-contrast PDA closure strategy as feasible alternative in renal dysfunction patients.
