Use of a Stent Graft for Patent Ductus Arteriosus in an Octo
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Open surgical repair of patent ductus arteriosus (PDA) is very invasive and challenging in elderly patients because of the use of cardiopulmonary bypass, the calcification of the duct, and the possibility of rupture. Endovascular repair using a coil or an occluding device can also be problematic because of migration, rupture, residual shunt, and other complications. Stent-graft treatment is a relatively less invasive procedure for PDA repair, resulting in fewer complications. However, PDA sometimes persists after stent-graft treatment, and residual ductus flow and pressure on the wall of the PDA is worrisome. We present here a case of adult PDA treated using a stent graft and show follow-up computed tomography (CT) images.

Case Report
PDA caused cardiac failure in an 81-year-old woman. A chest film showed lung congestion and bilateral pleural effusion. The concentration of serum brain natriuretic peptide (BNP) was 1180 pg/mL. Transthoracic echocardiography (TTE) revealed a PDA jet in the main pulmonary artery and mild tricuspid valve regurgitation. The pressure gradient of the tricuspid valve was 35 mmHg. CT showed pulmonary artery dilatation (50 mm) and a 9-mm PDA duct with a diameter of 17 mm at the pulmonary artery end and 14 mm at the thoracic artery end (Fig. 1). Aortography also showed shunt flow through the PDA. The pulmonary artery systolic pressure was 42 mmHg, with a substantial left-to-right shunt (shunt ratio, 63%; pulmonary-to-systemic flow ratio, 2.8; arterial oxygen saturation, 95%; and pulmonary artery saturation, 84.5%)....