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A 13 month old girl was admitted for transcatheter occlusion of a patent arterial duct. The echocardiogram showed a moderate sized duct with volume loading of the left ventricle. Angiography was performed before crossing the duct, and only a small sized duct was identified (panel A). The duct was uneventfully occluded with a 5 × 5 Cook detachable coil with no residual leak at the end of the procedure (panel B). The following day the coil had embolised to the right lower lobe pulmonary artery. Repeat angiography before coil retrieval now revealed a large, tubular duct (x) with aneurysmal dilation (xx) at the pulmonary end (panel C). The duct was occluded with a 6 × 8 Amplatzer duct occluder device (panel D).
Ductal spasm, when observed in the past, usually resulted from catheter manipulation to cross the duct. This case indicates that it may occur even spontaneously and echocardiographic findings should be taken into consideration when choosing an appropriate closure device.