failure of the duct closure between the pulmonary artery and the aorta is called patent ductus arteriosus ( pda).1 ) it is estimated that the incidence of pda is approximately 0.02% to 0.04% in term infants . however , depending on the estimated gestational age , the prevalence in preterm neonates varies from 20% to 60% on the third day of life . pda accounts for 6% to 11% of all congenital heart defects.2 ) isolated pda are categorized based on the degree of left to right shunting as mild , moderate and severe pda which can be subsequently complicated with eisemengers complex when there is reversal of shunting with progression to pulmonary hypertension . the clinical spectrum of presentation of a pda may range from a " silent " pda , one with no clinical manifestations but which is incidentally discovered on echocardiogram , to patients who present with congestive heart failure , pulmonary hypertension , signs of volume overload , endocarditis , atrial fibrillation , or recurrent pneumonia . the average age of death is 35 to 40 years.3 ) in korea no patient with pda over 70 years old has been reported . we report a first case in korea of pda with heart failure in octogenarian diagnosed and successfully occluded . a 80-year - old man visited the emergency room ( er ) due to aggravation of dyspnea for a week . he had diagnosed with hypertension nine years ago and blood pressure had been controlled well . he complained of dyspnea of new york heart association ( nyha ) iv classification at the time of er visitation . though he had a smoking history of 50 pack / years , his pulmonary function test which performed three weeks previously for an orthopedics operation showed normal range of lung function without any evidence of obstructive lung disease . he denied any history of cardiorespiratory problems , but stated that he had suffered dyspnea on exertion for a decade without any functional limitations in his routine activities . initial blood pressure was 100/60 mm hg , heart rate was 90/minute , respiratory rate was 22/minute and body temperature was 37.1. during checking of review of systems , he noted dyspnea and sputum but denied fever , cough , chest pain , and nocturnal dyspnea . upon physical examination , grade ii / vi systolic murmur best heard at the left upper sternal border in second intercostal space and the second heart sound was physiologically split , suggesting an absence of significant pulmonary hypertension . rales and wheezing sounds could be heard in both lung fields but pretibial pitting edema was n't obvious . chest x - ray showed cardiomegaly { cardiothoracic ( ct ) ratio=0.59 } and both pulmonary edema without pleural effusion ( fig . a transthoracic echocardiogram ( tte ) was performed and found visualized retrograde jet flow at main pulmonary artery , indicating presence of pda . tte also showed severe diastolic dysfunction and moderate pulmonary hypertension ( right ventricular systolic pressure=57.3 mm hg ) but preserved left ventricular function ( ejection fraction of left ventricle=52.6% ) . cardiac catheterization and aortic angiogram were done to confirm and check accurately the state of the pda , proving the presence of a connection between left pulmonary artery and distal aortic arch sized up to 3.1 mm ( fig . cardiac catheterization implied pda , showing a step up from right pulmonary artery to right ventricle ( 78.7% to 72.9% ) . the option of a transcatheter occlusion of pda had been suggested to the patient to relieve left to right shunt and improve heart failure . occlusion of pda with an amplatzer duct occlusion device was done and no shunt flow was seen in post - procedure aortogram ( fig . ct ratio ( 0.47 ) was decreased in the chest x - ray ( fig . 1b ) and a follow - up echocardiogram showed no visualized jet flow at the main pulmonary artery indicating successful closure of the pda . the end - diastolic dimension was 55.0 mm in m - mode while the right ventricular systolic pressure was 46.0 mm hg , indicating improvement of heart failure and pulmonary hypertension after the procedure . the patient continues to do well and has no symptom of heart failure or functional limitations without medication including diuretics . the ductus arteriosus is a vital fetal vascular structure thought to originate from the left sixth aortic arch during embryonic development that connects the main pulmonary artery to the descending aorta . the ductus diverts blood away from the high - resistance , unexpanded fetal circulation into the descending aorta and into the fetal arterial circulation.1 ) pda is the failure of the duct closure between the pulmonary artery and aorta and the third most common congenital cardiovascular anomaly , comprising approximately 10% of congenital anomalies or about 1 or 2 in 3000 live births.4 ) although most cases of pda would seem to occur sporadically , multifactorial inheritance is believed to underlie in many cases and these people are thought to possess a genetic predisposition.2 ) with improved survival of premature infants who are known to be at risk for pda and an increase in cases discovered incidentally on echocardiograms performed for another purposes , the apparent incidence of pda is rising . but presentation in adult life is rare since the lesion is usually diagnosed and closed surgically in infancy or early childhood.3)4 ) clinical manifestations of pda may vary among people and are dependent on size of the ductus , the age of the patient , the pressure differential across the ductus , and the presence or absence of pulmonary hypertension . some patients with an underlying pda may be highly symptomatic , presenting with congestive heart failure , pulmonary hypertension , signs of volume overload , atrial fibrillation , recurrent pneumonia , or other complications known to be associated with pda . hemodynamically significant adult pda has typically been associated with inexorable cardiovascular derangement , including congestive heart failure , infectious endocarditis , and pulmonary hypertension . but even among asymptomatic pdas who tolerated it for many years without clinical signs or symptoms , patients may become clinically significant with unrepaired pdas when acquired conditions such as recurrent pneumonia , the development of chronic obstructive pulmonary disease , or the manifestations of valvular or ischemic heart disease are superimposed.2 ) the average age of death is 35 to 40 years old and only occasionally can patients survive over 50 years.3 ) marquis et al . who studied 804 patients with pda in edinburgh between 1940 and 1979 noted that only 37 of them reached the age of 50.5 ) in our case , the patient was 80 years old and had had symptoms of heart failure such as dyspnea on exertion . cough and other symptoms had worsened at the time of er visitation . for adults , transcatheter occlusion of the patent ductus is the preferred treatment rather than surgery when possible.6 ) percutaneous occlusion using cathether based approaches such as amplatzer duct occlusion , coil occlusion device and rashkind umbrella device is the treatment of choice.2 ) transcatheter pda closure is safe and effective in patients with pulmonary hypertension except those with severe pulmonary hypertension.5)6 ) in one study , 139 patients with pda were hospitalized and transcatheter closures of pda were analyzed . after transcatheter closure , the nyha class and systolic pulmonary arterial pressure was significantly improved.5 ) in our case , though the patient was in old age and had n't had severe symptoms , he obviously has improved after percutaneous closure of pda . however , in adults with large , unfavorably shaped ducts , surgical ligation is the safe treatment of choice and effective alternative choice although calcification of the ductus may increase the technical difficulty of the procedure.7 ) we report a case of naive pda diagnosed at 80 years old with congestive heart failure and successfully closed with amplatzer duct occlusion . the hemodynamically significant pda resulted in volume overload of heart and the exhaustion of compensatory mechanisms leading to pulmonary edema and systemic hypoperfusion.8 ) pulmonary hypertension and congestive heart failure can be improved by occluding pda.5 ) we suggest that even in the case of pda in old age , occlusion of shunt should not be dismissed if shunt flow is enough to result in heart failure . treatment of choice must be decided case by case considering the size of the ductus , the pressure differential across the ductus , and the presence or absence of pulmonary hypertension , but transcatheter occlusion can be the clinician 's priority when possible .
patent ductus arteriosus ( pda ) is a rare clinical finding in adult patients . considering the increase in cases of pda discovered incidentally on echocardiograms at young ages , and the life - shortening effect of pda , it is rare to diagnose pda in old patients . 
 we report a case of an 80-year - old patient who experienced symptoms of congestive heart failure showed findings suggestive of pda in echocardiogram and confirmed the diagnosis through a cardiac catheterization and a coronary angiography . 
 after percutaneous occlusion of pda with an amplatzer duct occlusion device , symptoms related to congestive heart failure improved .