Endovascular Closure of Aortic Pseudoaneurysm Following Pulmonary Artery Vegetectomy for Residual Patent Ductus Arteriosus Endarteritis- a case report

Abstract Background: Residual patent ductus arteriosus (PDA) following surgical ligation is an uncommon occurrence that may predispose to infective endarteritis at the pulmonary artery end. Surgical vegetectomy may be required when antibiotic therapy fails. The development of an aortic pseudoaneurysm at the isthmus–descending thoracic aorta junction following trans-pulmonary artery vegetectomy and residual PDA closure is an extraordinary complication rarely documented in the literature. Case Presentation: A 2-year-old female underwent surgical ligation of a large PDA via left thoracotomy. Postoperative echocardiography revealed a 1 mm residual shunt. Six months later, she presented with high-grade fever and echocardiography demonstrated a 6 × 8 mm vegetation at the left pulmonary artery end of the residual PDA, which had enlarged to 3 mm. After failure of prolonged intravenous antibiotic therapy, surgical intervention was performed via sternotomy. Due to dense adhesions precluding external re-ligation, vegetectomy and PDA closure were accomplished from within the pulmonary artery using low-flow cardiopulmonary bypass under deep hypothermia. On subsequent follow-up, chest radiography revealed superior mediastinal widening, and CT angiography confirmed a pseudoaneurysm (5.5 × 3.8 × 3.7 cm) with eccentric thrombosis at the aortic isthmus–descending thoracic aorta junction, causing compression of adjacent structures. The pseudoaneurysm was successfully occluded percutaneously using an 8 mm Amplatzer plug via right femoral artery access, with post-deployment angiography confirming complete exclusion of the sac. Conclusion: Even trivial residual PDA shunts carry a lifelong risk of infective endarteritis. Post-discharge surveillance imaging is essential to detect occult complications following complex re-operations in infected fields, and multidisciplinary collaboration is critical to optimizing outcomes.