Circulation. 2005;112:e364-e365
doi: 10.1161/CIRCULATIONAHA.105.551440
(Circulation. 2005;112:e364-e365.)
© 2005 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Infected Patent Ductus Arteriosus
Ramarao S. Lankipalli, MBBS, MRCP;
Kevin Lax, MD;
Martin G. Keane, MD;
F. Michael Toca, MD;
Joseph E. Bavaria, MD;
Bonnie L. Milas, MD;
Victor A. Ferrari, MD;
Sridhar R. Charagundla, MD;
Frank E. Silvestry, MD
From the Cardiovascular Division, Department of Medicine (R.S.L., M.G.K., F.M.T., V.A.F., F.E.S.), Department of Cardiothoracic Surgery (J.E.B.), Division of Surgery, Department of Anesthesia (B.L.M.), and Department of Radiology (S.C.), Hospital of the University of Pennsylvania, Philadelphia, Pa; and Cardiology Division (K.L.), Holy Redeemer Hospital, Meadowbrook, Pa.
Correspondence to Frank E. Silvestry, MD, Assistant Professor of Medicine, Cardiovascular Division, Director, Penn Cardiac Care at Radnor, 250 King of Prussia Rd, Radnor, PA 19087. E-mail Fsilvest{at}mail.med.upenn.edu
Patent ductus arteriosus (PDA) is a common congenital abnormality that is associated with left-to-right shunting and risk of endocarditis. Percutaneous closure is now often recommended to prevent risk of endocarditis.
A 64-year-old male with a history of a small patent ductus arteriosus was admitted with 2 months’ history of intermittent fevers, chills, and muscle aches. Blood cultures at our institution grew Gamella species. Transthoracic echocardiography demonstrated a PDA with left-to-right shunting by color Doppler, with normal right heart size and pulmonary pressures.
Transesophageal echocardiography demonstrated a small calcified PDA that measured 1.7 cm long and had a 0.65-cm diameter with left to right color Doppler flow (Figure 1 through Figure 3
; Movie I and Movie II). A mobile vegetation was seen in the left pulmonary artery on the downstream side of the duct (Figure 1A and 1B; Movie I and Movie II). Interrogation with color and continuous-wave Doppler demonstrated continuous flow through the duct (Figure 2 and Figure 3; Movie III). Cardiac MRI confirmed a PDA, which measured 23 mm long and 9 mm in diameter, as well as a 9x6-mm density at the downstream aspect of the duct consistent with vegetation (Figure 4 and Figure 5).
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Figure 1. A, Two-dimensional transesophageal echocardiographic view of the vegetation (arrow) on the left pulmonary artery (PA) side of the patent ductus arteriosus (PDA), which is visualized in its long axis. Aorta (Ao). See Movie I. B, Similar image of the PDA in a short axis view demonstrating mobility of the vegetation. See Movie II.
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Figure 2. Color Doppler interrogation of the PDA, demonstrating continuous left-to-right shunting from the aorta (Ao) into the left pulmonary artery (LPA). See Movie III.
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Figure 3. Spectral display of the continuous-wave Doppler interrogation of the PDA, demonstrating continuous flow from aorta to pulmonary artery.
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Figure 4. Gadolinium-enhanced magnetic resonance angiogram in the sagittal oblique plane demonstrating an internal filling defect (arrow) in the PDA, representing the vegetation. Ao indicates aorta; PA, left pulmonary artery.
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Figure 5. Volume-rendered reformatted images obtained from magnetic resonance angiogram demonstrating PDA connecting aorta (Ao) and left pulmonary artery (LPA). RPA indicates right pulmonary artery.
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Treatment with vancomycin and gentamicin was instituted, and the patient underwent resection of PDA with homograft patch closure of the distal aortic arch and left pulmonary artery using cardiopulmonary bypass. He was discharged in stable condition on intravenous penicillin VK and gentamicin.
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Acknowledgments
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Disclosures
None.
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Footnotes
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The online-only Data Supplement, which contains Movie I, Movie II, and Movie III, can be found with this article at http://circ.ahajournals.org/cgi/content/full/112/25/e364/DC1.
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Circulation 2005 112: 3815.
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