A 9-month-old infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area with cardiomegaly on chest radiograph. What repair method is most appropriate?

A 9-month-old infant has a grade III/VI, harsh, rumbling, continuous murmur in the left infraclavicular fossa and pulmonic area with cardiomegaly on chest radiograph. What repair method is most appropriate?

• A. Cardiopulmonary bypass surgery
• B. Coil insertion in the catheterization laboratory
• C. Indomethacin administration
• D. Observation for spontaneous closure

Answer: (B)

The main idea here is closing a patent ductus arteriosus (PDA) in an older infant who already shows signs of a significant left-to-right shunt, like cardiomegaly and a continuous murmur. When a PDA persists beyond the neonatal period and the ductus is of suitable size and anatomy, closing it with a transcatheter device is the preferred approach. Coil occlusion performed in the catheterization lab is minimally invasive and effectively seals the ductus, reducing pulmonary overcirculation and improving cardiac workload without the need for open-heart surgery or bypass. Opening the chest and ligating the PDA under cardiopulmonary bypass would be more invasive and is usually reserved if a transcatheter closure isn’t possible or feasible due to anatomy or very small size. Using indomethacin is great for closing PDA in preterm neonates, but its effectiveness diminishes dramatically as infants get older, and at nine months it’s unlikely to be beneficial. Observation for spontaneous closure is unlikely to succeed here because the child already has a persistent murmur with cardiomegaly, indicating a hemodynamically significant PDA that would benefit from closure. So, coil occlusion in the catheterization lab is the best option for closing a PDA in this 9-month-old.

The main idea here is closing a patent ductus arteriosus (PDA) in an older infant who already shows signs of a significant left-to-right shunt, like cardiomegaly and a continuous murmur. When a PDA persists beyond the neonatal period and the ductus is of suitable size and anatomy, closing it with a transcatheter device is the preferred approach. Coil occlusion performed in the catheterization lab is minimally invasive and effectively seals the ductus, reducing pulmonary overcirculation and improving cardiac workload without the need for open-heart surgery or bypass.

Opening the chest and ligating the PDA under cardiopulmonary bypass would be more invasive and is usually reserved if a transcatheter closure isn’t possible or feasible due to anatomy or very small size. Using indomethacin is great for closing PDA in preterm neonates, but its effectiveness diminishes dramatically as infants get older, and at nine months it’s unlikely to be beneficial. Observation for spontaneous closure is unlikely to succeed here because the child already has a persistent murmur with cardiomegaly, indicating a hemodynamically significant PDA that would benefit from closure.

So, coil occlusion in the catheterization lab is the best option for closing a PDA in this 9-month-old.