Transcatheter Folded Valve Placement Within a Patent Ductus Arteriosus for Pulmonary Hypertension

BACKGROUND: Severe pulmonary arterial hypertension (PAH) with bidirectional patent ductus arteriosus (PDA) presents a challenge, as ductal closure is contraindicated. CASE SUMMARY: A 14-year-old boy with severe PAH and bidirectional PDA experienced exercise intolerance. He underwent transcatheter placement of a 20-mm folded Melody valve within the native PDA. The procedure eliminated diastolic left-to-right shunting while preserving systolic right-to-left shunting. At 1-year follow-up, he demonstrated durable unidirectional shunting and improved to NYHA functional class I status. DISCUSSION: While surgical valved reverse Potts shunts exist in the literature, adapting a transcatheter valve to create a unidirectional shunt within the native PDA percutaneously is novel. It offers a less invasive alternative for managing suprasystemic PAH. TAKE-HOME MESSAGES: Transcatheter folded valve placement within a native PDA safely establishes a unidirectional right-to-left shunt. This intervention reduces pulmonary overcirculation while maintaining vital ventricular decompression.