title: Combined interventional and surgical treatment for a rare case of double patent ductus arteriosus.
abstract: The present study describes the case of a 2.5-year-old girl with double patent ductus arteriosus (PDA) that was successfully treated following interventional and surgical treatment. Bilateral ductus arteriosus is a very rare condition, which is assumed to occur when the branchial-type arterial system transforms into the mammalian-type arterial system during the development of the aorta and its branches. This case was misdiagnosed as ordinary PDA by echocardiography prior to the first surgery and the surgery was not successful because of poor accessibility. Enhanced computed tomography subsequently showed situs solitus, atrial situs, levocardia, right-sided aortic arch with right-sided descending aorta, an isolated left subclavian artery and double PDA. Interventional treatment was performed and intraoperative aortic arch angiography showed that the descending aorta was the origin of the first funnel-type PDA (PDA-1). The left subclavian artery was not connected to the aorta but was connected to the pulmonary artery with a very narrow winding duct, which was PDA-2. Interventional treatment via PDA-2 also failed because passing a guidewire through the twisted PDA-2 was difficult. The child was immediately transferred to the surgical operation room for double PDA ligation and left subclavian artery reconstruction under median thoracotomy. The surgical procedure succeeded and the patient recovered quickly. The failure of the interventional treatment may be attributed to the difficulty in establishing a path. The soft tip of the hardened guidewire was relatively long. If the hardened part of the wire was sent to the appropriate place to support the pathway, the soft tip would be forced to enter the vertebrobasilar artery system. A similar problem was encountered when the left subclavian artery was selected for intervention. Shortening the length of the soft tip of the hardened guidewire may have enabled smooth completion of the establishment of the pathway. However, this type of hardened guidewire requires specific production.
authors.affiliation: Department of Intervention, Wuhan Asia Heart Hospital, Wuhan, Hubei 430022, P.R. China.
authors.forename: Xiao-Ke
authors.initials: XK
authors.lastname: Shang
authors.affiliation: Department of Intervention, Wuhan Asia Heart Hospital, Wuhan, Hubei 430022, P.R. China.
authors.forename: Gang-Cheng
authors.initials: GC
authors.lastname: Zhang
authors.affiliation: National Heart Research Institute of Singapore, National Heart Centre Singapore, Singapore 169609, Republic of Singapore; Cardiovascular Metabolic Disorder Programme, Duke-NUS Medical School, Singapore 169857, Republic of Singapore.
authors.forename: Liang
authors.initials: L
authors.lastname: Zhong
authors.affiliation: Department of Intervention, Wuhan Asia Heart Hospital, Wuhan, Hubei 430022, P.R. China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Intensive Care Unit, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China.
authors.forename: Mei
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Intervention, Wuhan Asia Heart Hospital, Wuhan, Hubei 430022, P.R. China.
authors.forename: Rong
authors.initials: R
authors.lastname: Lu
keywords: interventional; patent ductus arteriosus; surgical