Editorial Type:
Article Category: Research Article
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Online Publication Date: Apr 01, 2014

Evaluating Patent Ductus Arteriosus during Percutaneous Closure: Correlation between Intravascular Ultrasonography and Computed Tomographic Angiography

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Page Range: 238 – 239
DOI: 10.14503/THIJ-12-2914
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A 39-year-old man presented with dyspnea on exertion and was found on ausculation to have a continuous machinery-like murmur. A computed tomographic (CT) angiogram with 3-dimensional reconstruction showed a tubular patent ductus arteriosus (PDA) that measured 1.7 × 1.3 cm in diameter (Figs. 1 and 2). Given the large size of the defect, we entered the PDA with a peripheral intravascular ultrasound catheter (Volcano Corporation; San Diego, Calif ) to obtain ultrasonographic images (Fig. 3), which precisely confirmed the dimensions shown on the CT scan. Because of the defect's large size, we used an Amplatzer™ 20-mm vascular plug II (St. Jude Medical, Inc.; St. Paul, Minn) for closure (Fig. 4). Multiple aortograms verified cessation of left-to-right flow across the PDA, consistent with occlusion of the PDA (Fig. 5).

Fig. 1. Coronal image of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus (1.7 × 1.3 cm). / Ao = aorta; PA = pulmonary arteryFig. 1. Coronal image of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus (1.7 × 1.3 cm). / Ao = aorta; PA = pulmonary arteryFig. 1. Coronal image of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus (1.7 × 1.3 cm). / Ao = aorta; PA = pulmonary artery
Fig. 1 Coronal image of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus (1.7 × 1.3 cm). Ao = aorta; PA = pulmonary artery

Citation: Texas Heart Institute Journal 41, 2; 10.14503/THIJ-12-2914

Fig. 2. Three-dimensional reconstruction of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus. / Ao = aorta; PA = pulmonary arteryFig. 2. Three-dimensional reconstruction of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus. / Ao = aorta; PA = pulmonary arteryFig. 2. Three-dimensional reconstruction of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus. / Ao = aorta; PA = pulmonary artery
Fig. 2 Three-dimensional reconstruction of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus. Ao = aorta; PA = pulmonary artery

Citation: Texas Heart Institute Journal 41, 2; 10.14503/THIJ-12-2914

Fig. 3. Intravascular ultrasonographic image of a large patent ductus arteriosus (1.7 × 1.3 cm).Fig. 3. Intravascular ultrasonographic image of a large patent ductus arteriosus (1.7 × 1.3 cm).Fig. 3. Intravascular ultrasonographic image of a large patent ductus arteriosus (1.7 × 1.3 cm).
Fig. 3 Intravascular ultrasonographic image of a large patent ductus arteriosus (1.7 × 1.3 cm).

Citation: Texas Heart Institute Journal 41, 2; 10.14503/THIJ-12-2914

Fig. 4. Aortogram shows placement of the Amplatzer™ 20-mm Vascular Plug II within the patent ductus arteriosus. / Supplemental motion image is available for Figure 4.Fig. 4. Aortogram shows placement of the Amplatzer™ 20-mm Vascular Plug II within the patent ductus arteriosus. / Supplemental motion image is available for Figure 4.Fig. 4. Aortogram shows placement of the Amplatzer™ 20-mm Vascular Plug II within the patent ductus arteriosus. / Supplemental motion image is available for Figure 4.
Fig. 4 Aortogram shows placement of the Amplatzer™ 20-mm Vascular Plug II within the patent ductus arteriosus. Supplemental motion image is available for Figure 4.

Citation: Texas Heart Institute Journal 41, 2; 10.14503/THIJ-12-2914

Fig. 5. Aortogram shows closure of the patent ductus arteriosus with use of the Amplatzer Vascular Plug. / Supplemental motion image is available for Figure 5.Fig. 5. Aortogram shows closure of the patent ductus arteriosus with use of the Amplatzer Vascular Plug. / Supplemental motion image is available for Figure 5.Fig. 5. Aortogram shows closure of the patent ductus arteriosus with use of the Amplatzer Vascular Plug. / Supplemental motion image is available for Figure 5.
Fig. 5 Aortogram shows closure of the patent ductus arteriosus with use of the Amplatzer Vascular Plug. Supplemental motion image is available for Figure 5.

Citation: Texas Heart Institute Journal 41, 2; 10.14503/THIJ-12-2914

Comment

Various imaging methods have been used in the evaluation of PDA, including cardiac angiography, CT and magnetic resonance angiography, echocardiography, and intravascular ultrasonography (IVUS). Computed tomography has been used to evaluate PDA size and shape in preparation for percutaneous closure and has correlated well with echocardiography.1 Intravascular ultrasonography is helpful in delineating the size and other characteristics of a PDA, especially when echocardiographic images are insufficient.2 For example, IVUS provides insight into the structure of the vascular wall, including aneurysmal dilation and the presence and distribution of calcification.3 This, to the best of our knowledge, is the first report of the use of a peripheral IVUS catheter in the evaluation of a PDA during percutaneous closure; the catheter revealed excellent correlation between IVUS and CT angiography in the sizing of the PDA. Intravascular ultrasonography should be considered in lieu of CT in young patients to avoid unnecessary radiation exposure, as well as in patients with substantial renal impairment, allergy to contrast solution, or other contraindications to contrast administration. Indeed, one might choose to bypass CT altogether and use IVUS in all cases, because IVUS (in our judgment) should be considered the gold standard for the measurement of vascular size. This eliminates the need for contrast solution and potentially could reduce costs. Intravascular ultrasonography can be a useful imaging technique at the time of percutaneous closure for the sizing and characterization of a PDA, especially if CT angiographic data are not available.

References

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Copyright: © 2014 by the Texas Heart® Institute, Houston
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Fig. 1
Fig. 1

Coronal image of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus (1.7 × 1.3 cm).

Ao = aorta; PA = pulmonary artery

Fig. 2
Fig. 2

Three-dimensional reconstruction of a contrast-enhanced computed tomographic scan shows a large patent ductus arteriosus.

Ao = aorta; PA = pulmonary artery

Fig. 3
Fig. 3

Intravascular ultrasonographic image of a large patent ductus arteriosus (1.7 × 1.3 cm).

Fig. 4
Fig. 4

Aortogram shows placement of the Amplatzer™ 20-mm Vascular Plug II within the patent ductus arteriosus.

Supplemental motion image is available for Figure 4.

Fig. 5
Fig. 5

Aortogram shows closure of the patent ductus arteriosus with use of the Amplatzer Vascular Plug.

Supplemental motion image is available for Figure 5.

Contributor Notes

From: Division of Cardiology, Department of Medicine (Drs. LaBarbera, Slater, and Staniloae) and Department of Medicine (Dr. Storch), NYU Langone Medical Center, New York, New York 10016

Section Editor: Raymond F. Stainback, MD, Department of Adult Cardiology, Texas Heart Institute, 6624 Fannin St., Suite 2480, Houston, TX 77030

Address for reprints: Matthew LaBarbera, MD, Division of Cardiology, Department of Medicine, NYU Langone Medical Center, 550 First Ave., New York, NY 10016