Patent ductus arteriosus (PDA) is one of the most common congenital heart defects, and causes left ventricular volume overload. However, it is a rare finding among adults due to the lack of symptoms related to its small size, and it is not usually associated with other congenital lesions.

A 53-year-old woman was referred for percutaneous closure of a PDA. She had undergone a secundum atrial septal defect (ASD) closure in 2007, detected after a cryptogenic stroke. After this procedure, her clinical history was remarkable for fatigue, dyspnea and orthopnea with New York Heart Association (NYHA) functional class III, and a continuous murmur was heard over the left sternal border. A routine transthoracic echocardiogram performed in 2013 revealed a continuous flow from the aorta towards the pulmonary artery, with left-sided chamber dilation (ejection fraction 50%) and normal pulmonary artery pressure. The device previously implanted at the atrial septum was correctly positioned and without residual shunt (Figure 1). The PDA was closed by placing an Amplatzer™ Duct Occluder guided by fluoroscopy and intracardiac echocardiography (Figure 2). The procedure was uneventful. The 12-month follow-up showed significant clinical improvement (NYHA functional class II), no residual shunt, and normal left chamber dimensions (Figure 3).

Figure 1.

Transthoracic echocardiogram (parasternal short-axis view): color Doppler displays a continuous turbulent flow from the aorta to the left branch of the pulmonary artery, consistent with a patent ductus arteriosus.

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Figure 2.

Fluoroscopy during percutaneous patent ductus arteriosus closure: left, a continuous flow can be seen from the aorta to the pulmonary artery (yellow arrow); center, during device placement (yellow arrow); right, after the procedure the device is properly positioned with no residual shunt (yellow arrow).

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Figure 3.

Transthoracic echocardiogram after patent ductus arteriosus closure (parasternal short-axis view): left, an image consistent with the closure device (yellow arrow); right, on color Doppler the turbulent flow is no longer seen.

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In this case, the association with an ASD may have delayed the clinical manifestations of the PDA, as the previous left-to-right shunt probably compensated for the left ventricular volume overload. It is crucial to perform a complete high-quality echocardiogram in such patients with congenital heart disease, in order to screen for associated anomalies.