Balloon-assisted TorqVue TM delivery catheter advancement for residual patent ductus arteriosus closure in a postsurgical infant with Edwards syndrome

Patent ductus arteriosus closure is usually straightforward, but prior surgical ligation may create barriers to device delivery. We describe a 1.5-month-old infant (2.9 kg) with Edwards syndrome, large ventricular septal defect, and clinically significant residual patent ductus arteriosus after pulmonary artery banding and surgical ligation. Catheterisation via 4F femoral venous access confirmed a 2.5 mm patent ductus arteriosus. An Amplatzer Piccolo Occluder 4/2 mm was planned, but delivery proved difficult. Three approaches failed: telescoping (0.014″ wire, Progreat 2.8F, and TorqVue 4F), wire escalation with multipurpose catheters and 0.018″/0.035″ exchanges, and a long 4F Flexor sheath. Obstruction at the patent ductus arteriosus level was consistent with suspected residual surgical ligature. As bailout, a 2.0 × 15 mm Ryurei coronary balloon was gently hand-inflated only to fill the TorqVue tip and used to advance the system across the obstruction. This enabled successful occluder deployment with complete closure. Residual patent ductus arteriosus after surgery may pose unique challenges; balloon-assisted sheath advancement is a simple and effective bailout when conventional techniques fail.