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OBJECTIVE:
Closure of patent ductus arteriosus (PDA) in the elderly is a high-risk procedure because of the fragility of the aorta and aneurysmal changes in the ductus. The alternative is endovascular treatment which is a minimally invasive procedure that uses PDA closure devices. An optional procedure would be the stent graft (SG) technique which has emerged as a method for treating aortic aneurysm. We report three PDA cases treated by the SG technique.
METHODS:
From September 2009 to September 2011, three patients received an SG for PDA with aneurysmal changes. The proximal landing zone was straight and >2 cm in length. The number of neck vessels that were debranched depended on the treatment strategy employed for each patient.
Case 1: A 77-year-old woman was admitted for persistent heart failure with recurrent PDA. She had undergone an aortic valve replacement and had surgery twice for PDA closure. She required axillo-axillary artery bypass before the SG procedure which was inserted through the common iliac artery from zone 2 to T 9.
Case 2: A 70-year-old woman was admitted with heart failure and supraventricular tachycardia. She required debranching of three neck vessels branching from the ascending aorta under the beating heart. An SG was inserted through the ascending aorta simultaneously from zone 0 to T 9.
Case 3: A 55-year-old woman was admitted with heart failure, pulmonary hypertension, and severe aortic valve stenosis. She underwent a bypass from the left common carotid artery to the left subclavian artery, and an SG was simultaneously inserted through the common iliac artery from zone 2 to T 8. She subsequently underwent aortic valve replacemen.RESULTS:
The median follow-up period was 5 months (range, 4-12 months). No 30-day mortality was observed; moreover, there were no cases of cardiac or aortic complications or type 1 endoleakage. Late mortality was observed in one patient who suffered an intracerebral hemorrhage 12 months after the SG procedure.
CONCLUSIONS:
The endovascular technique for closure of PDA with aneurysms was successfully performed in three high-risk patients.