Infected Patent Ductus Arteriosus
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 9×6-mm density at the downstream aspect of the duct consistent with vegetation (Figure 4 and Figure 5⇓).
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.
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.