Delayed occluder displacement following patent ductus arteriosus closure successfully managed with thoracic endovascular aortic repair: a case report and literature review

Abstract

Interventional occlusion of Patent ductus arteriosus (PDA) is generally efficacious and complications such as delayed occluder displacement are infrequent. Herein, we report a case of 24-year-old female with a history of unsuccessful PDA closures, who subsequently experienced delayed occluder displacement into the left main pulmonary artery. Despite numerous unsuccessful catheter-based interventions, thoracic endovascular aortic repair (TEVAR) was successfully executed. This procedure effectively resolved the PDA without any postprocedural complications. This case highlights the efficacy and safety of TEVAR as a viable alternative for managing complex PDA cases involving occluder displacement.

Keywords: Late complications; Patent ductus arteriosus; Thoracic endovascular aortic repair.

Fig. 1

(A) Preoperative TTE shows a left-to-right shunt (red arrow) between the descending aorta (DAO) and the PA, measuring; (B) Preoperative TTE reveals a displaced occlusion device (red arrow) with an adjacent left-to-right shunt. (C) Preoperative TEE demonstrates a 12 × 5.5 mm colour flow between the DAO and the LPA at PA end. (D) Preoperative TEE indicates that the arterial duct has an opening with a diameter of 10 mm at the descending aorta. (E) Preoperative aortic CTA identifies a displaced occlusion device (red arrow) situated in the left pulmonary artery, which has since become endothelialized. (F) Preoperative aortic CTA again highlights the displaced occlusion device (red arrow). (G) Preoperative aortic CTA suggests that a portion of the occlusion device has with the pulmonary artery wall, measuring 12 × 6 mm, consistent with preoperative TEE findings. (H) Intraoperative digital subtraction angiography (DSA) reveals the displaced occlusion device and a reopened arterial duct (red arrow) between the aorta and pulmonary artery. (I) Intraoperative DSA shows the released CUFF stent positioned in the descending aorta, providing structural support. (J) The Vailant™ Stent Graft (Medtronic, USA) is partially deployed, with customized fenestrations (red arrows) on the stent for the left subclavian artery. K. Intraoperative DSA shows the stent deployed in zone 2, with the metallic markers aligned to the greater curvature of the aortic arch. The left subclavian artery is clearly visible, and the arterial duct is securely occluded. L. The stent graft is correctly positioned. TTE, transthoracic echocardiography; DAO, descending aorta; PA, pulmonary artery; TEE, transesophageal echocardiography; AOAR, aortic arch; LPA, left pulmonary artery