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Background
The open repair of a patent ductus arteriosus (PDA) in the elderly can be a high-risk operation due to aneurysmal and degenerative changes to the aorta that occur over time. Thoracic stent grafts (TSG) have emerged as viable therapy for endovascular repair of thoracic aortic aneurysms. We report the use of a thoracic stent graft to close a PDA.
Methods
A 76 year-old female who was followed for several years for a known PDA was referred for evaluation due to worsening pulmonary hypertension. She noted progressively increasing shortness of breath over the last several months. Cardiac catheterization with selective pulmonary artery catheterization revealed pulmonary arterial pressures of 60 mmHg. Electively the patient underwent exposure of the left common femoral artery and advancement of a TSG into the thoracic aorta. Pulmonary artery catheter was placed during the operation and pressures were monitored throughout. A Medtronic Valiant device was landed at Zone 2 proximally, extending distally past the PDA.
Results
Completion aortogram demonstrated no flow into the pulmonary arterial system, and pulmonary artery pressures dropped after deployment to 25 mmHg. The patient was seen in followup upwards of 4 months later with resolution of her shortness of breath.
Conclusion
This hybrid and novel approach to treating a PDA in the elderly is well tolerated and viable solution to a complex problem.