Handle With Care: A Ductus Arteriosus Aneurysm in an Elderly Patient

J INVASIVE CARDIOL 2017;29(8):E96-E97.

Key words: ductus arteriosus aneurysm, cardiac imaging

A 76-year-old hypertensive woman was hospitalized for recurrent dyspnea at rest and pedal edema, in a setting of heart failure with preserved ejection fraction. Her medical history included endovascular treatment for an aneurysm of the abdominal aorta and a recent hospital admission for bilateral pleural effusion. During the present hospitalization, a patent ductus arteriosus (PDA) was suspected at echocardiography. Angiographic computed tomography confirmed the finding of a PDA (Figure 1A) and showed that it originated from an aneurysm at the level of the aortic isthmus, identified as a ductus arteriosus aneurysm (DAA; maximum diameter, 61 mm) (Figures 1A, 1B).

Cardiac catheterization was performed. Aortography clearly depicted the DAA as a saccular dilation of the ampulla of the ductus arteriosus (Figure 1C). Significant left-right shunt through the PDA (Qp/Qs, 3.4) and postcapillary moderate pulmonary hypertension were measured.

Surgical correction of the DAA was excluded due to the high risk of the intervention and the frailty of the patient. Percutaneous closure of the PDA was performed to correct the shunt and an 18 mm Amplatzer patent foramen ovale occluder was implanted (Figure 1D). The choice of the device, with its double-anchoring disk, was dictated by the elevated pulmonary pressure, which was feared to possibly displace a conventional PDA occluder. 

DAA is a rare finding, with sporadic cases reported (the vast majority in children and infants).¹ In the elderly, it poses serious therapeutic challenges, as the risk of rupture is counterbalanced by the high risk of its correction,² which requires surgery or placement of an endovascular prosthesis in a critical region such as the aortic arch.^3,4

References 

1.    Suzue M, Mori K, Hayabuchi Y. Congenital ductus arteriosus aneurysm. J Echocardiogr. 2012;10:112-114.

2.    Psathas ED, Katsargyris A, Lioudaki S, Moris DN, Doulaptsis M, Klonaris C. Treatment paradigms for ductus arteriosus aneurysms in adults. Vascular. 2014;22:297-301.

3.    Murana G, Cefarelli M, Kloppenburg G, Morshuis WJ, Heijmen RH. Surgical exclusion of a saccular aneurysm within a patent ductus arteriosus in an adult patient with Ortner’s syndrome. Future Cardiol. 2016;12:613-616.

4.    Zhang FW, Li H, Tong J, Li FX, Cai SR. Endovascular stent-graft exclusion of adult giant patent ductus arteriosus through a hybrid transabdominal approach. Ann Thorac Surg. 2013;95:696-699.

From the Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted March 14, 2017.

Address for correspondence: Sebastiano Gili, MD, Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin Corso Dogliotti 14, 10126, Turin, Italy. Email: sebastiano.gili@gmail.com