Case Presentation By Dr. Islam Galal Sayed Ahmed Assistant - PowerPoint PPT Presentation

Case Presentation By Dr. Islam Galal Sayed Ahmed Assistant Lecturer at Cardiology Department , Faculty of Medicine , Zagazig University

Marked Improvement Of Left Ventricular Function And Valvular Regurgitation After Percutaneous Closure Of Patent Ductus Arteriosus

Introduction  Patent ductus arteriosus (PDA) is a congenital anomaly causing left ventricular (LV) volume overload, which may be a compensatory phenomenon to maintain systemic cardiac output.

 Previous reports demonstrated that PDA closure led to immediate deterioration of LV systolic function, which recovered within 6 months in children.  Furthermore, LV remodeling and changes in LV systolic function after PDA closure in adult patients have not been sufficiently reported. .

Case  29 year-old female suffering from dyspnea and palpitation with rapid AF was examined.  Echocardiography showed 15mm PDA causing severe pulmonary hypertension.

 She had moderate mitral regurgitation (MR) and moderate aortic regurgitation (AR) with healthy leaflets.  LV dimensions were dilated. Ejection fraction (EF) was 47%.

Procedure  We decided to close the PDA percutaneously .  Balloon closure test of PDA was done first using sizing balloon for 20 minutes.  Mean pulmonary artery pressure significantly decreased (from 72mmHg to 47mmHg) and LV systolic pressure improved (from 85mmHg to 123mmHg).

 We closed the PDA using ASD Amplatzer occluding device of size 17mm with good result without significant residual shunt.

Follow Up  1month later, no significant shunt was detected by echocardiography,  LV size was reduced,  MR and AR were both reduced from GIII/IV to GII/IV.  EF became 62%.  AF was controlled without digoxin.  4 months later, the patient was symptom free.

Discussion  Recently, Eerola et al demonstrated, using 2- and 3- dimensional echocardiography, that changes in LV volume and function caused by PDA closure disappeared by 6 months after percutaneous closure in children.  our current case demonstrated that LV recovered during the long-term follow-up period in adult PDA patients.

Cont. Discussion  Recently, transcatheter device occlusion has become the first choice treatment for adult PDA.  There are several publications describing subsequent deterioration of LV systolic function after PDA closure.

 Reduced muscle fiber stretch by the sudden reduction in LV volume overload and increased LV afterload may be the cause.  Deterioration after PDA closure is more pronounced in adults than in children because the LV has been subjected to prolonged remodeling induced by the volume overload .

Conclusion  PDA device closure reduces LV size and improves its function.  Valvular regurgitation could be improved after PDA closure providing that the leaflets are healthy.  Hence, it doesn't necessarily motivate surgical closure.

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