Rare Case of Peripherally Calcified Ductus Arteriosus Aneurysm in an Adult
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A 46-year-old woman presented with complaints of shortness of breath (New York Heart Association II) for the past 3 years. There was no history of orthopnea or paroxysmal nocturnal dyspnea, nor of trauma or previous aortic or cardiovascular surgery.
Upon examination, her blood pressure and heart rate were normal, and there was a mild cardiomegaly with the left ventricular type of cardiac apex. The second sound was normally split with a continuous machinery murmur best heard over the left infraclavicular area. A resting electrocardiogram showed sinus rhythm with normal intervals. There was notable calcification of the aneurysmal dilated patent arterial duct. An echocardiography showed mildly dilated left-sided chambers, with normal cardiac valves, and a patent arterial duct aneurysm (PDA) measuring 8 mm at the pulmonary artery (PA) end, shunting left to right. The arch was left-sided with no coarctation. The ventricular function was preserved with no evidence of pulmonary arterial hypertension.
Computed tomography angiography revealed the presence of a PDA (measuring 8 mm at the PA end) with aneurysmal dilatation (measuring 25 x 21 mm) and peripheral calcification (Figure 1). No thrombus was seen within the aneurysmal sac, and no surrounding hematoma was seen. The aortic arch was left-sided with a normal branching pattern. No aortic coarctation, tortuosity, or dissection was seen.
The management options were discussed in the combined meeting involving cardiac surgeons, radiologists, and cardiologists, and with the family before deciding to proceed for transcatheter closure using an Amplatzer Duct Occluder (ADO I) (Abbott). (Figure 2). The procedure was done under local anesthesia (Videos 1-6). An arch injection using a 5-French (Fr) diagnostic pigtail angiography catheter (Cordis) was obtained to define the anatomy of the PDA in the lateral and right anterior oblique views. As the PA end measured 8 mm, it was decided to use a 12/10 ADO I device to close the defect. The PDA was crossed from the PA end using a 0.035-inch, double-length, Amplatz Super Stiff guidewire (Boston Scientific), which was exchanged for a double-length stiff wire. Over the stiff wire, using an 8-Fr delivery system, the 12/10 ADO I device was deployed under echocardiographic and fluoroscopic guidance. The device was released after confirming the position with a check angiogram and an echocardiographic assessment. The patient was discharged after 24 hours and found symptomatically improved at 12 months of follow-up.
Ductus arteriosus aneurysms (DAA) are uncommon cardiovascular lesions, generally detected incidentally in the antenatal or neonatal period. Presentation in the adult age group is rare. Moreover, available literature shows very few case reports describing the patency of the arterial duct in adult patients with DAA. Though the majority of these lesions are incidental, they may be associated with serious complications including rupture, infection, and mass effect leading to airway or esophageal compression, erosion, and thromboembolism.
Affiliations and Disclosures
Drs Sharma and Bhatia share first authorship.
From the Departments of 1Radiodiagnosis and 2Cardiology, PGIMER, Chandigarh, India.
Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.
Consent statement: Informed consent was given by the patient for the procedure(s) described in the manuscript.
Address for correspondence: Sanjeev H Naganur, DM, Department of Cardiology, PGIMER, Chandigarh 160012, India. Email: drsanju.h.n@gmail.com
