A 23-year-old female, was admitted to the hospital, with progressive shortness of breath on exertion, chest pain, palpitation, and fatigability over the last four years. Six months back she had undergone cesarean section (LSCS). During pregnancy, she had severe shortness of breath and it worsened as the pregnancy progressed. During LSCS she collapsed and had a cardiac arrest which was successfully resuscitated. Cardiology evaluation showed large PDA.

On clinical examination, she had continuous murmur over the upper part of the left chest. Her chest x-ray showed bilateral prominent bronchovascular marking. CT angiogram revealed large PDA with shunt. It also showed dilated left atrium and left ventricle with severe pulmonary congestion. Echocardiogram showed PDA with dilated left ventricle and LVEF 60%. Anatomically this PDA was not suitable for device closure.

Surgical Procedure

Through posterolateral thoracotomy, PDA was dissected and doubly ligated under hypotensive anesthesia. Additionally, she had a medium size vascular clip placed at the aortic side of the PDA. She had an uneventful recovery and was discharged on seventh post-operative day.

Discussion

Patent ductus arteriosus in the adult is an extremely rare phenomenon. This condition should have been diagnosed much earlier. Aneurysm, endocarditis and calcification are a few of the serious sequelae as the age advances. There are various methods to treat this condition. Open surgical division or ligation has traditionally been an extremely successful and safe method of PDA closure. Comparative results are now achievable using transcatheter devices in majority of the cases.

Congenital heart disease in adults with patent ductus arteriosus (PDA) - Burjeel