Patent ductus arteriosus in adults – etiology of an infective endocarditis

Introduction: Patent ductus arteriosus is a congenital heart abnormality which can be isolated or associa-ted with interatrial or interventricular septal defect. It occurs more frequently in females and if it is not di-agnosed at birth it can develop in the long run heart failure. Eisenmenger syndrome occurs at the time of equalization of pulmonary and systemic pressure, with reversal of the shunt direction. In adults, the closure of the isolated patent arterial duct is preferably percu-taneous. If surgical treatment is recommended, percu-taneous pre-treatment is preferred to reduce the risk associated with extracorporeal circulation. Sometimes, patent ductus arteriosus is discovered through compli-cations such as infective endocarditis, ductus arteriosus aneurysm or pulmonary hypertension.

Methods: T he case describes a 65-year-old woman, who was diagnosed with patent arterial duct while in-vestigating the etiology of an infectious endocarditis. She also associates dilated cardiomyopathy with mode-rate systolic dysfunction, left ventricular aneurysm and chronic renal disease and was hospitalized for chest pain („burns”) which increased in intensity over the last 2 weeks and dyspnea at medium-small efforts. The patient was submitted to cardiac catheterization in or-der to evaluate the possibility of transcatheter closure of the duct and cardiac resynchronization.

Results: Clinical examination – systolic-diastolic heart murmur at the left upper chest, infraclavicular and in-terscapular area. Biohumoral – inflammatory syndro-me and decreased GFR. The electrocardiogram descri-bes left ventricular hypertrophy and left bundle branch block. Echocardiography – dilated left ventricle with diffuse hypokinesis (ejection fraction 37%) and apical aneurysm, hypertrophy of the basal interventricular septum (no gradient in LVOT), patent ductus arteri-osus with left-to-right shunt. Cardiac catheterization and angiography: normal coronary arteries, the lateral wall of left ventricle allows the placement of pacema-ker leads, mild pulmonary hypertension with increased pulmonary vascular resistance and moderate biventri-cular systolic dysfunction.

Conclusions: Patent ductus arteriosus is a congenital heart abnormality which in the absence of percutaneo-us or surgical treatment invariably leads to death. The particularity of this case is the lack of specific symptoms until adulthood when due to an infective endocarditis patent ductus arteriosus is diagnosed. In this context, given the associated co-morbidities, it is essential to set up a multidisciplinary in-hospital team to choose the therapeutic strategy with maximum benefit over short and long-term prognosis.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)