Successful Transcatheter Closure of a Residual Patent Ductus Arteriosus with Complex Anatomy after Surgical Ligation Using an Amplatzer Ductal Occluder Guided by Live Three-Dimensional Transesophageal Echocardiography

Abstract

Residual patent ductus arteriosus (PDA) after surgical ligation is not common, but the anatomy of the residual duct may be distorted by the surgical ligation resulting in a difficult transcatheter closure. Such distorted anatomy of the duct may not be demonstrated by the two-dimensional transesophageal echocardiography (2D TEE). Fortunately, live 3D TEE provided the precise anatomy of the elongated distorted residual duct, and as in the case presented herein, guided the Amplatzer ductal occluder (ADO). We concluded that live 3D TEE provided novel images of complex residual ducts and successful guidance of a ductal occluder.

Echocardiography for Patent Ductus Arteriosus Including Closure in Adults

“…The lowest velocity obtained from the continuous-flow Doppler tracings taken as the end-diastolic gradient can help in the selection of coils for percutaneous ductal occlusion. [42][43][44] Real Time (Live) 3DTEE: 40 The PDA with a lower end-diastolic gradient (less than 38 mmHg) may require the use of multiple or larger coils.…”

“…44 Contrast Echocardiography: Peripheral intravenous contrast echocardiography has been used to noninvasively identify an otherwise undetectable PDA that manifests as central right-to-left shunt at the ductal level in cyanotic patients with Eisenmenger's physiology. It allows delineation of the anatomical details or its variations, confirms the position of the device after closure and rules out any residual shunts.…”

“…Color Doppler 3DTTE can also demonstrate flow signals moving from the pulmonary artery into the descending thoracic aorta in systole and back into the pulmonary artery in diastole. [42][43][44] Real Time (Live) 3DTEE:…”

Live/Real Time Three‐Dimensional Transesophageal Echocardiography

“…With the available live 3DTEE technology, the operator's confidence is likely to go up in dealing with complex congenital defects percutaneously in the coming days. In a report of transcatheter closure of residual patent ductus arteriosus, where after a failed attempt under 2DTEE, 57 a 3DTEE examination revealed a distorted and elongated anatomy of the duct which led to a change in the strategy from antegrade to retrograde approach with successful completion of the procedure.…”

Trans‐pulmonary echocardiography as a guide for device closure of patent ductus arteriosus

“…Practically, there have been no imaging modalities except for trans‐esophageal echocardiography (TEE) that allows us to monitor the entire procedure of DC‐PDA . However, a major disadvantage of TEE is that it requires endotracheal intubation and general anesthesia.…”