Transcatheter Potts Shunt in Pulmonary Arterial Hypertension After Patent Ductus Arteriosus Closure.

Abstract

We report the case of an 18-year-old female with progressive, end-stage pulmonary arterial hypertension (PAH) despite receiving maximal triple combination therapy. The patient had a history of patent ductus arteriosus (PDA) closure at 15 months of age. Due to a pulmonary hypertensive crisis during anesthesia induction, a transcatheter Potts procedure was successfully performed under extracorporeal membrane oxygenation (ECMO) support, involving covered stent implantation just below the previous PDA occluder. At the 3-month follow-up, the patient demonstrated significant clinical improvement, shifting to WHO class II-III, with a dramatic decrease in NT-proBNP (5406-512 pg/ml) and an increased 6-min walk distance (< 300 to 390 m). This case achieved short-term recovery of cardiac function and long-term maintenance of pulmonary vascular stability and demonstrates that the transcatheter Potts shunt is a feasible and effective life-prolonging treatment option for severe PAH, even in patients with a history of prior PDA closure.