Restored left ventricular function following transcatheter closure of a persistent ductus arteriosus in an adult.

ABSTRACT

Recently, transcatheter device occlusion has become the first choice treatment for adult persistent ductus arteriosus (PDA). However, various complications such as atrial fibrillation requiring anticoagulation, pulmonary hypertension, and ventricular dysfunction may challenge the interventionist. We report a 61-year-old patient with a large PDA complicated by left ventricular dysfunction, atrial fibrillation, and left atrial thrombus. Computed tomography documented the PDA of Krichenko type A with the narrowest diameter of 8 mm. We successfully closed the PDA using an Amplatzer duct occluder under anticoagulation with wafarin. His post-operative course was complicated by ventricular tachycardia and deteriorating left ventricular pump function. Although endomyocardial biopsy from the left ventricle showed myocardial hypertrophy and interstitial fibrosis, possibly caused by chronic volume overload, left ventricular pump function improved dramatically with restoration of sinus rhythm during follow-up. Left ventricular dysfunction, even when associated with histological changes, may be nearly normalized by volume unloading in an adult with a large PDA. <Learning objective: Transcatheter device occlusion has become the first choice for adult persistent ductus arteriosus (PDA). It is important to note various complications associated with transcatheter occlusion of PDA in adult, such as arrhythmia, pulmonary hypertension, and ventricular dysfunction. Temporally dysfunction of left ventricular (LV) systolic performance usually occurs following PDA closure, because of reduced muscle fiber stretch by the sudden reduction in LV volume overload and increased LV afterload. Although histological remodeling of LV may be caused by volume overload due to significant left-to-right shunt in adults, volume unloading can, not only prevent further deterioration of LV function, but also may also reverse the substrate of arrhythmia.>.