Off-Label 16-mm VSD Occluder for Closure of a Giant PDA With Severe Pulmonary Hypertension
Abstract
Background: Giant patent ductus arteriosus (PDA) with pulmonary hypertension often presents unique challenges for closure, requiring extensive expert team discussion.
Case-summary: A 17-year-old girl with syncopal episodes, intermittent chest pain, and continuous cardiac murmur was diagnosed with a 12.5-mm PDA. After a few months of pulmonary vasodilator therapy, pulmonary vascular resistance (PVR) improved from 7 WU to 5.5 WU, and treatment with closure using a 16-mm ventricular septal defect (VSD) occluder proceeded. Post-procedure, symptoms resolved along with left ventricular remodeling.
Discussion: Off-label use of VSD occluders is increasing for treatment of large PDAs. In high-risk patients, careful hemodynamic assessment, trial occlusion, and staged pulmonary vasodilator therapy optimize outcomes. For controversial borderline PVR (5-8 WU), closure decisions should rely on comprehensive evaluation by adult congenital heart disease and pulmonary hypertension specialists rather than PVR alone.
Take-home messages: Muscular VSD occluders provide a viable alternative for large PDA closure with complex anatomy. In borderline PVR (5-8 WU), decisions should rely on comprehensive evaluation by adult congenital heart disease and pulmonary hypertension specialists rather than PVR alone.
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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