Patent ductus arteriosus clipping and coarctation of the aorta

Case contributed by Ashesh Ishwarlal Ranchod

Presentation

A loud murmur, continuous during systole and diastole, was heard at a routine check-up.

Patient Data

Age: 5 months
Gender: Male

CT imaging confirms coarctation of the thoracic aorta. The thoracic aorta is narrowed just distal to the left subclavian artery. The patent ductus arteriosus was poorly delineated on CT, however, the cardiac echo confirmed this expected finding. High osmolar intravenous iodinated contrast media often causes artefacts (beam hardening and streak) on the routine non-modified soft tissue windows as is the case here. Windowing or reviewing bony windows can improve CT assessment, especially in CT angiographic studies (well demonstrated by the bony windows above).

Preoperative CT reconstructed 3D images and multiplanar reconstructed images demonstrate an infantile preductal coarctation of the aorta.

Post operative X-ray

x_ray

Chest X-ray demonstrates dual titanium hemostatic surgical clips.

Normal cardiomediastinal contour.

The descending thoracic aorta is poorly identified and no obvious features to suggest coarctation of the aorta.

Case Discussion

This infant presented with a continuous, loud murmur at a routine pediatric check-up.

On the cardiac echogram and CT angiogram, an infantile, pre ductal coarctation of the aorta and patent ductus arteriosus were confirmed.No other congenital cardiac anomalies were found, specifically, no tetralogy of Fallot, no Eisenmenger syndrome, no hypoplastic left heart and no pulmonary atresia. In addition, no aortic or mitral valve abnormalities were present.

The infant underwent open surgical management, specifically a left posterolateral thoracotomy and open dilatation of the coarctation and surgical clipping of the patent ductus arteriosus. 

Postoperatively, the infant presented with new onset of seizures and a request was made for an MRI brain examination. Although surgical hemostatic ligation clips are usually made of titanium and one can perform an MRI study immediately, a decision was made to rather perform a CT brain and wait a short period for healing and granulation tissue to form before performing an MRI study.

 

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