Transcatheter closure of patent ductus venosus in an adolescent using a KONAR-Multifunctional Occluder device.

Abstract

Patent ductus venosus (PDV) is a rare intrahepatic congenital portosystemic shunt that can result in hepatic encephalopathy and hepatopulmonary syndrome due to diversion of portal blood away from hepatic metabolism. Although typically diagnosed in infancy, PDV may rarely remain undetected until adolescence. Management of late presenters is challenging, as abrupt closure of large shunts may precipitate portal hypertension, and coil embolization carries a higher risk of systemic migration. We report a 16-year-old boy presenting with unexplained hypoxemia (SpO₂ 84% on room air), digital clubbing, and hyperammonemia. Bubble contrast echocardiography demonstrated an extracardiac right-to-left shunt, while abdominal imaging confirmed a large PDV with associated diffuse pulmonary arteriovenous malformations. Temporary balloon occlusion testing demonstrated hemodynamic suitability for closure. Transcatheter occlusion using a Konar-Multifunctional Occluder resulted in significant improvement in arterial oxygen saturation and normalization of serum ammonia levels, sustained during one-year follow-up. This case highlights the importance of meticulous hemodynamic assessment and demonstrates the safety and efficacy of the Konar-MFO device in late-presenting PDV.