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A 68 year old woman presented with new onset of dyspnoea and fatigue. Thirty years previously she was diagnosed as having a patent ductus arteriosus. At that time the left-to-right shunt across the patent ductus was found to be 33%, and no evidence of pulmonary vascular disease was present. A transcatheter closure of the patent ductus arteriosus was performed percutaneously using an Ivalon plug with a metallic skeleton as occluder device (Porstmann and Wierny: Z Gesamte Inn Med, 1968).
Thirty years later the patients lung and renal function were well preserved; the ECG and laboratory values did not show any abnormalities and could not help elucidate the patient’s symptoms. Transthoracic echocardiography showed normal systolic function but reduced early transmitral velocity compared with increased atrial velocity and shortened deceleration time.
However, multiplane transoesophageal echocardiography (panel A) demonstrated the correct position of the Ivalon occluder (size 11 × 13 × 8 mm) (arrow).
Between the pulmonary trunk (P) and the proximal descending aorta (Ao) just distal to the left subclavian artery, the smooth wrapping (envelope) of the Ivalon plug is seen. A left-to-right shunt was excluded. The diastolic dysfunction was confirmed with left and right heart catheterisation. The angiogram of the aorta (panel B) demonstrates the metal nucleus (skeleton) of the occluder device (arrow). There was no evidence of coronary artery disease, valvar heart disease, left-to-right or right-to-left shunt with correct position of the ductus occluder more than three decades after percutaneous placement.