Progressive coarctation after device closure of arterial duct – Case report

Abnormalities of the isthmus are often noted with patent arterial duct in childhood. Varying degrees of coarctation can be associated with patent arterial duct. While both defects can be tackled by percutaneous interventions, the strategy depends on the age of presentation and the severity of the condition. A two-year-old boy was identified to have a moderate patent arterial duct during evaluation of an incidentally detected cardiac murmur. Echocardiography suggested mild isthmic narrowing which was confirmed on angiography. The pullback gradient was 4 mmHg, and he underwent device closure of the arterial duct. He presented again at 11 years of life with severe coarctation of aorta and upper limb hypertension. The duct occluder was in position. An uncovered stent was deployed at the site of coarctation which relieved the obstruction with favorable follow up outcomes. The sequential interventional approach is a suitable option for children with patent arterial duct associated with sinusoidal arches with minimal physiological significance in infancy. Progressive coarctation after PDA device closure.