Evaluating Patent Ductus Arteriosus during Percutaneous Closure: Correlation between Intravascular Ultrasonography and Computed Tomographic Angiography

Abstract

A 39-year-old man presented with dyspnea on exertion and was found on ausculation to have a continuous machinery-like murmur. A computed tomographic (CT) angiogram with 3-dimensional reconstruction showed a tubular patent ductus arteriosus (PDA) that measured 1.7 × 1.3 cm in diameter (Figs. 1 and ​and2).2). Given the large size of the defect, we entered the PDA with a peripheral intravascular ultrasound catheter (Volcano Corporation; San Diego, Calif ) to obtain ultrasonographic images (Fig. 3), which precisely confirmed the dimensions shown on the CT scan. Because of the defect's large size, we used an Amplatzer™ 20-mm vascular plug II (St. Jude Medical, Inc.; St. Paul, Minn) for closure (Fig. 4). Multiple aortograms verified cessation of left-to-right flow across the PDA, consistent with occlusion of the PDA (Fig. 5). Fig. 1 Coronal image of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus (1.7 × 1.3 cm). Fig. 2 Three-dimensional reconstruction of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus. Fig. 3 Intravascular ultrasonographic image of a large patent ductus arteriosus (1.7 × 1.3 cm). Fig. 4 Aortogram shows placement of the Amplatzer™ 20-mm Vascular Plug II within the patent ductus arteriosus. Fig. 5 Aortogram shows closure of the patent ductus arteriosus with use of the Amplatzer Vascular Plug.