PMC7683341_01
Chest X-ray before and one day after PDA device closure. There is cardiomegaly with prominent pulmonary artery (PA)conus. Lung congestion is more significant before PDA device closure.(the arrows point to the PA conus and the PDA device).
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fig1
There is significant prominence of the main pulmonary artery conus (Fig. 1A). Chest X-ray one day after PDA device closure revealed a decrease in pulmonary congestion (Fig. 1 B).
12 Lead ECG, showing evidence of right atrial enlargement, the axis is more toward the right side, with biventricular hypertrophy, mainly RVH.
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There is evidence of biventricular hypertrophy (R waves and S waves in both right and left precordial leads) with more ECG signs of RVH (Fig. 2).
Echocardiographic views before PDA device closure. A- Two Dimensional and color compare, high left parasternal view (ductal cut) (Ao = Aorta, PA = Pulmonary artery).B- Continuous-wave (CW) Doppler tracing of the flow across PDA (Low gradient between the aorta and the pulmonary artery). C- Abdominal aorta Pulse wave (PW) Doppler, showing pulsatile systolic flow with a holo-diastolic reversal.D- 4 Chamber view showing right ventricular (RV) dilatation. (LV = left ventricle). E- Long axis view, showing RV dilatation. F- Short axis parasternal view at the papillary muscle level. There is significant RV dilatation. The interventricular septum (IVS) is pushed toward the left ventricle (LV) (flattening of IVS and D-shaped LV). G- Short axis subcostalview. There is significant RV dilatation. The interventricular septum (IVS is pushed toward the left ventricle (LV). . (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)
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No pericardial effusion (Fig. 3).
Cardiac catheterization during PDA device closure (arrows point to the PDA and PDA device). A- Straight lateral view, showing the MPA2 catheter crossing from the pulmonary artery (PA) side to the aorta (AO). B- Postero-anterior view with 20  right anterior oblique (RAO) angulation, with an injection through the long delivery sheath. C- Lateral view post-PDA device closure. The Device still attached to the delivery cable.
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The post-procedure angiogram revealed that the device is in a good position with no compromisation to the arch or branch pulmonary arteries (PAs) (Fig. 4).