Percutaneous closure of an unusually large patent ductus arteriosus in a patient with a giant pulmonary artery and congenital single coronary artery

RevPortCardiol.2016;35(7-8):451---452

www.revportcardiol.org

Revista

Portuguesa

de

Cardiologia

Portuguese

Journal

of

Cardiology

IMAGE

IN

CARDIOLOGY

Percutaneous

closure

of

an

unusually

large

patent

ductus

arteriosus

in

a

patient

with

a

giant

pulmonary

artery

and

congenital

single

coronary

artery

Encerramento

percutâneo

de

canal

arterial

patente

invulgarmente

largo

num

doente

com

artéria

pulmonar

gigante

e

artéria

coronária

única

Bekir

Serhat

Yildiz

,

Yusuf

Izzettin

Alihanoglu,

Ismail

Dogu

Kilic,

Harun

Evrengul

DepartmentofCardiology,PamukkaleUniversity,MedicalFaculty,Denizli,Turkey

Received1September2015;accepted22November2015 Availableonline8July2016

Alarge patent ductusarteriosus in apatient withagiant

pulmonaryarteryandcongenitalsinglecoronaryarteryisa

rarecongenitalcardiovascularmalformation.Inthisreport,

wepresentimagesandvideosofthepercutaneousclosureof

anunusuallylargepatentductusarteriosusina33-year-old

manwithhighpulmonaryarterypressure.

A 33-year-oldmanwasdiagnosed witha patentductus

arteriosus (PDA)shortly after birth, but wasthen lost to

follow-up. He had no symptoms and receivedno medical

treatment untilhepresentedwitha one-monthhistoryof

progressive dyspnea and palpitations. On physical

exami-nation he had a prominent left ventricular impulse with

a loud continuous murmur. There was no evidence of

cyanosis, clubbing, or peripheral edema. His chest X-ray

showedcardiomegalyandenlargementoftheleftpulmonary

hilum,and an electrocardiogram revealed sinus

tachycar-diawithincompleterightbundlebranchblock(Figure1A).

AtransthoracicechocardiogramrevealedaPDAwith left-to-rightshunt(pulmonary/systemicflow[Qp/Qs]ratioof1.6), leftventricular ejection fraction of 60% andenlargement oftherightheartchambersandtheleftpulmonaryartery,

∗_{Correspondingauthor.}

E-mailaddress:bserhatyildiz@yahoo.com(B.S.Yildiz).

in addition to severe pulmonary hypertension. Contrast computed tomography revealed a PDA (approximately 16 mm in diameter at its narrowest portion) connecting theaortic isthmus (immediatelydistal andinferior tothe leftsubclaviantakeoff)tothemain pulmonaryarteryand coexistentwitha giantleft pulmonary artery(80.32 mm) (Figure 1B and C). Coronary angiographyshowed a single coronary artery that originated from the right coronary artery (Figure 1D and Videos 1 and 2). During cardiac catheterization, peak systolic pulmonary artery pressure wasmeasuredat 110mmHgandpulmonary vascular resis-tance was 4.8 Wood units. Vasoreactivity testing with adenosine was negative. A sizing balloon (Amplatzer Siz-ing Balloon II, St. Jude Medical, USA), diameter 20 mm, wasusedandthe ductwasmeasured at 17 mmin length by6mm inwidthat itsnarrowestdiameter(Figure1E).A fallinsystolicpulmonaryarterypressureofmorethan30% duringballoonocclusionwasourcriterionforproceedingto transcatheterclosure(Video3).ThePDAwassubsequently successfullyrepaired usingan 18 mm Amplatzermuscular ventricularseptaldefectoccluder(AMVSD)(St.Jude Medi-cal,St.Paul, MN,USA) (Figure1F andVideo4). Arepeat echocardiogramaftertheprocedureatone-yearfollow-up showed no evidence of residual shunting and progressive decreasesinpulmonaryarterydiameter(71mm)andright ventricularchamberdiametersandpressures.

http://dx.doi.org/10.1016/j.repc.2015.11.026

452 B.S.Yildizetal.

A

B

Giant pulmonary artery

C

F

E

D

Figure1 (A)ChestX-rayshowingcardiomegalyand enlarge-mentoftheleft pulmonaryhilum(bluearrow);(B)computed tomography (CT) image revealing a patent ductus arteriosus (PDA)inthefrontalplane(bluearrow);(C)CTimageshowing agiantleftpulmonaryartery(8.32cm);(D)coronary angiogra-physhowingasinglecoronaryarteryoriginatingfromtheright coronaryartery; (E)sizingballoonmeasuringthediameterof thePDA; (F)the duct isoccluded by anAmplatzer muscular ventricularseptaldefectoccluder.

Inconclusion,off-labeluseoftheAMVSDmaybe consid-eredfor theocclusionoflargePDAsinadultpatientswith highpulmonaryarterypressure.

Ethical

disclosures

Protection of human and animal subjects.The authors declarethatnoexperimentswereperformedonhumansor animalsforthisstudy.

Confidentialityofdata.Theauthorsdeclarethattheyhave followedtheprotocolsoftheirworkcenteronthe publica-tionofpatientdata.

Right to privacy and informed consent.The authors declarethatnopatientdataappearinthisarticle.

Financial

support

This researchreceived nospecific grantfromany funding agency,eithercommercialornot-for-profit.

Conflicts

of

interest

Theauthorshavenoconflictsofinteresttodeclare.

Appendix

A.

Supplementary

material

Supplementary material associated with this article can be found in the online version at doi:10.1016/j.repc. 2015.11.026.