Management of a hemodynamically significant patent ductus arteriosus in a three-year-old child through transcatheter device closure

Management of a hemodynamically significant patent ductus arteriosus in a three-year-old child through transcatheter device closure: A case report and clinical outcome analysis

Janani^1*, Sripreethi, Hemalatha³, Jayamenon⁴

¹Staff Nurse, Kauvery Hospital, Heart city, Trichy, Tamil Nadu

²Nurse Educator, Kauvery Hospital, Heart city, Trichy, Tamil Nadu

³Assistant Nursing Superintendent, Kauvery Hospital, Heart city, Trichy, Tamil Nadu

⁴Nursing Superintendent Kauvery Hospital, Heart city, Trichy, Tamil Nadu

*Correspondence

Abstract

Patent Ductus Arteriosus (PDA) is a common congenital heart disease in children. A 3-year-old female child presented with poor weight gain and was evaluated for congenital heart disease. Echocardiography revealed a large PDA measuring about 4 mm with left-to-right shunt and left atrial/left ventricular dilatation. The child was admitted for transcatheter PDA device closure. The procedure was successfully performed using a 6 × 8 mm device with good post-procedure recovery. The patient remained hemodynamically stable and was discharged in satisfactory condition.

Key words: Patent Ductus Arteriosus (PDA); Echocardiography

Introduction

Patent ductus arteriosus is a congenital cardiac anomaly in which the ductus arteriosus fails to close after birth. Persistent patency causes abnormal blood flow from the aorta to the pulmonary artery, leading to pulmonary over circulation, cardiac chamber enlargement, recurrent respiratory infections, and failure to thrive. Early diagnosis and timely intervention help prevent complications such as pulmonary hypertension and heart failure. Device closure through cardiac catheterization is now the preferred minimally invasive treatment for suitable PDA cases.

Case Presentation

A 3-year-old female child weighing approximately 8.1–8.4 kg presented with history of poor weight gain. The child had previously been evaluated for congenital heart disease. There was no history of major respiratory distress at admission. Echocardiography performed earlier revealed congenital heart disease in the form of a large PDA. The child was admitted for further management and planned PDA device closure.

Relevant Clinical Findings

General condition stable and conscious.

Weight: approximately 8.1–8.4 kg.
Height: 79 cm.
Heart rate ranged from 142–166 beats/min.
Respiratory rate around 20–30 breaths/min.
SpO₂ maintained between 96–100% on room air.
Blood pressure around 90/60 to 100/60 mmHg.
Cardiovascular examination suggestive of congenital heart disease.
No significant respiratory distress noted.
Peripheral perfusion and circulation were adequate.

Relevant Investigations

Echocardiography Findings showed:

Large PDA measuring approximately 4 mm.
Left-to-right shunt.
Dilatation of left atrium and left ventricle.
Good biventricular function.

Laboratory and Monitoring

Routine blood investigations performed prior to procedure.
Continuous monitoring of pulse, blood pressure, respiratory rate, and oxygen saturation during admission and post-procedure period.

Diagnosis

Congenital heart disease – Large Patent Ductus Arteriosus (PDA) with left-to-right shunt and left heart dilatation.

Management

The patient was admitted under pediatric cardiology care. Pre-procedure stabilization and investigations were completed.

Medical Management

Intravenous fluids administered.
Injection Ceftriaxone prescribed.
Monitoring of intake, output, and vital signs.
Interventional Procedure
Transcatheter PDA device closure was planned and performed.

Lab Investigation

Investigation Name	Result	Unit Reference Range
Haemoglobin	8.3 g/dL	13–17
Packed Cell Volume (PCV)	25.00%	40–54
Total RBC Coun	2.91 ×10⁶/µL	4.5–6.0
Mean Corpuscular Volume (MCV)	85.9 fL	80–96
Mean Corpuscular Haemoglobin (MCH)	28.5 pg	27–32
Mean Corpuscular Haemoglobin Concentration (MCHC	33.2 g/dL	32–36
RDW-CV 16.2 %
Total WBC Count	19110 Cells/Cumm4000–10000
Neutrophil	76.90%	40–75
Lymphocyte	11.10%	25–40
Monocyte	6.40%	1–8
Eosinophil	5.30%	1_6
Basophil	0.30%	0–1
Absolute Neutrophil Count (ANC)	14700 cells/µL	2500–7000

Procedure report

ECG

Other investigations

Abdomen scan

Procedure details

Right femoral venous access obtained under aseptic precautions.
Aortogram and echocardiographic guidance used during procedure.
PDA crossed successfully.
A 6 × 8 mm Life tech PDA occlude device deployed across the duct.
Post-deployment echocardiography confirmed stable device position with no residual significant shunt.

Outcome

The child tolerated the procedure well. Post-procedure vitals remained stable:
SpO₂ maintained around 98–100%.
Hemodynamically stable.
No immediate complications observed.
Femoral access site remained normal.
Recovery was uneventful.

Discharge

The patient was discharged in stable condition after successful PDA device closure with advice for:

Regular pediatric cardiology follow-up.
Monitoring for fever, breathing difficulty, or limb swelling.
Maintenance of adequate nutrition for catch-up growth.
Follow-up echocardiography as advised.

Discussion

Patent ductus arteriosus results in persistent communication between the aorta and pulmonary artery. Large PDAs can produce significant left-to-right shunting, causing increased pulmonary blood flow and enlargement of left heart chambers. Clinically, affected children may present with failure to thrive, recurrent respiratory infections, tachycardia, and cardiac murmurs.

In this case, poor weight gain was the major presenting complaint. Echocardiography confirmed a hemodynamically significant PDA with left heart dilatation. Since the child was symptomatic and had evidence of volume overload, device closure was indicated.

Transcatheter PDA closure is considered safe and effective in suitable pediatric patients. Compared with surgical ligation, it offers shorter hospital stay, minimal invasiveness, rapid recovery, and fewer complications. Successful closure in this child prevented further cardiac volume overload and future complications.

Conclusion

This case highlights the importance of early recognition of congenital heart disease in children presenting with poor weight gain. Echocardiography played a key role in diagnosis. Timely transcatheter PDA device closure resulted in successful management with good clinical outcome and stable recovery.

References

American Heart Association. (2022). Guidelines for the management of congenital heart disease in children. American Heart Association.
Moss & Adams’ Heart Disease in Infants, Children, and Adolescents. (2016). In R. E. Shaddy, T. F. Feltes, & J. F. Cetta (Eds.), Moss & Adams’ heart disease in infants, children, and adolescents: Including the fetus and young adult (9th ed.). Wolters Kluwer.
Muller’s Pediatric Cardiology. (2021). In H. K. Singh & A. Kumar (Eds.), Pediatric cardiology: A clinical guide (3rd ed.). Jaypee Brothers Medical Publishers.
European Society of Cardiology. (2020). Guidelines for the management of adult congenital heart disease. European Heart Journal, 41(43), 4153–4154.
Park’s Pediatric Cardiology for Practitioners. (2021). In M. K. Park (Ed.), Park’s pediatric cardiology for practitioners (8th ed.)

Management of a hemodynamically significant patent ductus arteriosus in a three-year-old child through transcatheter device closure

Management of a hemodynamically significant patent ductus arteriosus in a three-year-old child through transcatheter device closure: A case report and clinical outcome analysis

Janani1*, Sripreethi, Hemalatha3, Jayamenon4

Nightingale Journals

Janani^1*, Sripreethi, Hemalatha³, Jayamenon⁴