Karuru Uma Devi, Tummala Sadanand Reddy, Naveen T, Mysore Sai Kumar, Kanjerla Kiran Kumar
Department of Cardiology, ESIC Medical College and Super Speciality Hospital, Room no 107, 1 st floor, Sanath Nagar, Hyderabad, 500038, India.
Egypt Heart J. 2024 Dec 20;76(1):160. doi: 10.1186/s43044-024-00595-y.
Patent ductus arteriosus (PDA) is a congenital heart defect that requires closure to prevent complications like heart failure and pulmonary hypertension. Catheter-based closure using devices such as the Amplatzer duct occluder is the preferred method due to its minimally invasive nature. However, device embolization is a rare but recognized complication, particularly in small children or high-flow PDAs.
We report a rare and complex case of spontaneous embolization of a PDA closure device into the descending aorta in an 11-month-old female. The patient, with a history of recurrent lower respiratory tract infections and poor weight gain, underwent a PDA closure procedure after a thorough assessment. During the procedure, the Amplatzer Duct Occluder I device unexpectedly migrated into the descending aorta. Despite initial attempts at percutaneous retrieval using a goose neck snare, the device lodged in the left common iliac artery due to size discrepancy. Further snaring was abandoned to prevent the risk of artery dissection. The patient was then taken for emergency surgical exploration. The cardiovascular surgical team successfully retrieved the device through a left supra-inguinal incision, with no complications post-surgery. The patient showed improved limb perfusion and was discharged one week later.
This case underscores the importance of meticulous procedural planning, multidisciplinary collaboration, and adaptive decision-making in managing rare and challenging complications during PDA device closure. The successful outcome, despite the complex nature of the complication, highlights the effectiveness of combining percutaneous and surgical approaches in pediatric cardiology.
动脉导管未闭（PDA）是一种先天性心脏缺陷，需要进行闭合以预防心力衰竭和肺动脉高压等并发症。由于具有微创性，使用诸如Amplatzer动脉导管封堵器等装置进行基于导管的闭合是首选方法。然而，装置栓塞是一种罕见但已被认识到的并发症，尤其是在幼儿或高流量动脉导管未闭的情况下。
我们报告了一例罕见且复杂的病例，一名11个月大的女性，其动脉导管未闭封堵装置自发栓塞至降主动脉。该患者有反复下呼吸道感染病史且体重增加不佳，在经过全面评估后接受了动脉导管未闭封堵手术。在手术过程中，Amplatzer I型动脉导管封堵器意外迁移至降主动脉。尽管最初尝试使用鹅颈圈套器经皮取出，但由于尺寸差异，该装置卡在左髂总动脉。为防止动脉夹层风险，放弃了进一步圈套。随后患者接受了急诊手术探查。心血管外科团队通过左腹股沟上切口成功取出该装置，术后无并发症。患者肢体灌注改善，一周后出院。
该病例强调了在动脉导管未闭装置闭合过程中处理罕见且具有挑战性的并发症时，精心的手术规划、多学科协作和适应性决策的重要性。尽管并发症性质复杂，但成功的结果凸显了儿科心脏病学中经皮和手术方法相结合的有效性。
