Percutaneous Closure of the Persistent Ductus Arteriosus in Adults

Persistent ductus arteriosus (PDA) is defined by the persistence of the DA beyond the first 3 months of life. Natural closure normally occurs 24 to 48 hours after birth. Discovery is rare in adulthood. This was a retrospective study of patients with PDA discovered in adulthood and who underwent percutaneous closures (PC) of PDA. Patients were collected over a period from 2009 to 2018. Eleven PC of PDA in adults were performed. The average age of discovery of PDA was 22 years. While the average age for percutaneous treatment was 25 years (18 to 33 years). There was a female predominance (9 women). All the patients were symptomatic. The circumstances of discovery of PDA were as follows: NYHA stage II dyspnea in 9 patients and bronchopulmonary infections in 2 patients. On the chest x-ray, 4 patients had cardiomegaly. On ECG, 10 patients had a left axis. Six patients had electrical LVH. On TTE, the left cavities were dilated in 10 patients. The pulmonary artery (PA) was dilated in 3 patients. LVEF was preserved in 100% of cases. At the TTE the averaged channel diameter was 5.2 mm (from 3 to 8 mm). The maximum average gradient between the aorta and the PA was 78.6 mmHg. The average SPAP was 32.5 mmHg. There were 4 patients who had PAH. No other heart disease was associated. The most common type of PDA was type A (8 patients). The average size of the prosthesis (amplatzer) put in was 8/7 mm. The 11 PDAs were closed successfully, without immediate complications. Angiographic and TTE in the KT room showed minimal residual shunt in 4 patients, and eliminated an aortic and pulmonary obstacle. In the short-term (3 months), all patients were asymptomatic. On TTE LV measurements normalized, SPAP were normal, all prostheses were in place, and there is no residual shunt. The duration of follow-up was 26 months. PDA is a common congenital heart disease. It can remain asymptomatic for a long time and does not appear until adulthood. PC is the treatment of choice.