Two-Stage Treatment for Adult Large Patent Ductus Venosus

Abstract

Patent ductus venosus is a congenital portosystemic shunt that may cause progressive portal hypertension, hepatic encephalopathy, and focal nodular hyperplasia of the liver. Embolization of the Arantius' duct is the first choice of treatment in infants and children. However, it carries the risk of coil migration into the systemic circulation in adult patients with larger Arantius ducts. Additionally, the primary closure of the Arantius' duct may result in acute portal hypertension. Herein, we present a two-stage treatment for adult patent large ductus venosus (Arantius' duct). A 23-year-old female patient with hypoalbuminemia showed a patent large Arantius' duct (diameter = 45 mm), intrahepatic portal venous hypoplasia, and multiple hepatic nodules with dynamic computed tomography (CT). Preoperative angiography showed the absence of the intrahepatic portal vein, and tentative occlusion of the Arantius' duct increased the portal pressure from 9 to 15 mmHg with visualization of only a few portal branches. Therefore, we conducted a two-stage treatment for the Arantius' duct. In the first stage, we used an open approach to perform angioplasty of the Arantius' duct to reduce the size from 45 to 8 mm in diameter, which gradually increased the intrahepatic portal blood flow in the follow-up CT scan. The second-stage embolization of the Arantius' duct was performed using an interventional procedure via the internal jugular vein 4 months after the first stage. The patient's recovery was uneventful, and post-treatment CT showed increased intrahepatic portal flow. Serum albumin value increased from 2.7 to 3.7 g/dL 2 weeks post-treatment.