Unusual presentation of a patent ductus arteriosus: A case report


A 48 years old patient, with no medical history was referred to the cardiovascular surgeon of our department for a right medio-ventricular resection diagnosed after 2 episodes of syncope. The transthoracic echocardiography revealed a severe RV hypertrophy with aspect of sub-pulmonary stenosis. An invasive hemodynamic assessment was performed and concluded to a severe Pulmonary arterial hypertension. During the invasive right cardiac exploration, the catheter run easily into an unknown large patent ductus arteriosus (PDA). PDA in adults is an extremely rare clinical phenomenon since it is usually discovered and treated during childhood. However, physicians need to be aware of potential situations, signs and symptoms that might suggest a previously undiagnosed PDA.

Although few epidemiological data are available on the relationship between adult congenital heart disease and pulmonary arterial hypertension (PAH), a European survey reported that approximately 5-10% of patients with adult congenital heart disease were found to have PAH.1 In most of these patients, prolonged exposure to pulmonary over circulation due to a left-to-right shunt, as well as pressure overload in some cases, can lead to pulmonary arteriopathy that results in a significant increase in pulmonary vascular resistance (PVR). The correct diagnosis of the underlying cause of pulmonary arterial hypertension is essential. Patients with congenital heart disease (CHD)may have an atypical presentation and be referred to expert centers with an incorrect diagnosis. A full investigation is necessary. Careful examination of right ventricular anatomy can provide clues about the etiology of pulmonary hypertension (PH), and it is important to exclude intra- and extracardiac shunts during hemodynamic studies. We report a clinical case of PAH in the context of an overlooked patent ductus arteriosus in adulthood with right ventricular (RV) consequences.

https://www.stephypublishers.com/sojccts/pdf/SOJCCTS.MS.ID.000506.pdf



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