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

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.