An adult patient with patent ductus arteriosus: multimodality diagnostic approach

Abstract

A 20 year-old man was admitted to the hospital with exertional dyspnoea (NYHA class II). Auscultation of his chest revealed a harsh, grade 3/6 continuous murmur which was loudest at the second left intercostal space; there were no signs suggestive of volume overload, ventricular failure, or raised pulmonary pressures. Chest X-ray demonstrated mild cardiomegaly with normal pulmonary vasculature, and electrocardiogram revealed normal sinus rhythm with no features of ventricular strain or atrial enlargement. Transthoracic echocardiography (TTE) (IE33 Matrix probe, Philips Medical Systems, Bothell, WA, USA) revealed a mean left ventricular ejection fraction of 60%. Left heart chambers and pulmonary artery were dilated. Initial TTE showed the presence of a large (1.65 cm2) window-like patent ductus arteriosus (PDA) in the suprasternal notch view. Colour floor M-mode echocardiography demonstrated a continuous left to right shunting from the aorta into the left pulmonary artery (Figs. 1A, B). Two-dimensional (2D) transoesophageal echocardiography (TEE) revealed a large window-like PDA (Figs. 1C, D). A subsequent real-time 3D TEE (3D RT TEE) revealed the presence of a large PDA (1.65 cm2) (Figs. 1E, 2A–D). Contrast enhanced thorax computed tomography (CT) demonstrated a large PDA with no additional cardiac abnormality (Figs. 3A, B). Ambulatory Holter recordings were normal. The patient was referred to cardiac surgery.