Residual Patent Ductus Arteriosus After Surgical and Transcatheter Closure: Anatomical Challenges and Transcatheter Re-Intervention Strategies.

Abstract

Objective: The aim of this study was to present our single-center experience with transcatheter re-intervention for residual patent ductus arteriosus (rPDA), with particular emphasis on anatomical features and technical approaches.

Method: We retrospectively reviewed six patients (median age 2.9 years; range, 1.2-16) who underwent transcatheter closure of rPDA between January 2021 and May 2025. Re-intervention was performed for persistent residual shunting in the presence of previously implanted foreign material, based primarily on hemodynamic and anatomical considerations; infective endarteritis and hemolysis were considered additional potential risks. Procedural records, angiographic findings, device selection, and outcomes were analyzed.

Results: Five patients had undergone prior transcatheter patent ductus arteriosus (PDA) closure and one had surgical ligation. Among the transcatheter cases, persistent shunting was due to delayed malposition (n = 2), incomplete occlusion (n = 2), and a non-thrombosed coil (n = 1). In two patients, the original Amplatzer Duct Occluder II (ADO II) device was malpositioned toward the pulmonary artery; therefore, a second device was deployed encompassing the prior occluder. In one patient, a non-thrombosed coil with persistent central flow created a 'stent-like' configuration, and closure was achieved by implanting a new device with its discs covering the coil. In the surgical case, both the residual ductus and an adjacent aortopulmonary collateral artery were successfully occluded with a single device. Complete closure was achieved in all patients without complications.

Conclusion: In this single-center case series, transcatheter re-intervention for residual PDA was feasible even in the presence of malpositioned prior devices. Careful anatomical evaluation and individualized procedural planning enabled successful closure of residual shunts.