Three-dimensional rotational digital angiography in a complicated case of patent ductus arteriosus transcatheter closure.

There has been no report so far as to the usefulness of 3D rotational angiography in congenital heart disease interventions. We present a case of a difficult patent ductus arteriosus in which 3D rotational angiography was the key to successful closure. A 64-year-old woman who had been operated on many years previously for a patent ductus arteriosus came to our attention for a heart murmur on the left upper sternal border. Echocardiography revealed a still patent duct with moderate shunt. The patient underwent cardiac magnetic resonance imaging, which confirmed patency of the duct, but its diameter and length were difficult to measure due to the particular orientation and morphology of the previously legated duct. It was decided to attempt device closure. Three-dimensional rotational digital subtraction technique enabled us to find the most useful projection for measuring the duct and selecting the best implant device (coil or Amplatzer device). The exact oblique and cranio-caudal degree of the selected projection on rotational 3D reconstruction was replicated to obtain the best standard digital subtraction angiographic view of the duct. Thus, a 5/4-mm Amplatzer Duct Occluder was selected and successfully implanted with excellent results. This case suggests that 3D rotational angiography may be an important imaging tool to guide congenital heart disease interventions such as patent ductus arteriosus closure or aortic coarctation repair.