Transcatheter Closure of a Large Patent Ductus Arteriosus in three Pregnant Women

Abstract

BACKGROUND Hemodynamically significant PDA during pregnancy requires closure to reduce risk of maternal and fetal mortality and morbidity. But PDA device closure during pregnancy is complex in light of elevated maternal and fetal risk as well as radiation exposure to the fetus.

CASE PRESENTATION
Case 1: A 22-year-old female referred for PDA device closure. She was 26 weeks pregnant. She presented with the complaint of shortness of breath and palpitation before pregnancy, and an increase in the above symptoms for a month. A 14x16 ADO device was used to close the PDA. An echocardiogram was used to confirm closure of the duct. The total fluoroscopy time for this procedure was 0.7 min with radiation exposure of 9.5 mGy.
Case 2: A 28-year-old female referred for PDA device closure by the cardiac surgeon. She was 28 weeks pregnant. She presented with the complaint of shortness of breath for 3 weeks. A 16x18life tech PDA device ADO device, was used to close the PDA. An echocardiogram was used to confirm closure of the duct. The total fluoroscopy time for this procedure was 1.3 min with radiation exposure of 28 mGy. An echocardiogram performed the next day following device implantation demonstrated no evidence of obstruction to either branch pulmonary artery or across the aorta, and no residual shunting across the duct. 
Case 3: A 31 years old female referred for PDA device closure. She was G2P1 with 26 weeks pregnant. She presented with the complain of shortness of breath of 4 weeks. A 16x18life tech PDA device was used to close the PDA. Echocardiogram was used to confirmed closure of the duct. The total fluoroscopy time for this procedure was 1.5 min with radiation exposure of 28mGy. An echocardiogram performed next day following device implantation, demonstrated no evidence of obstruction to either branch pulmonary artery or across the aorta and, no residual shunting across the duct.

CONCLUSIONS Unrepaired PDA discovered late in pregnancy poses management challenges. With our experience of doing adult PDA, we could do the procedure with very short exposure to radiation of the fetus.