Surgical Treatment of Patent Ductus Arteriosus in High-Risk Adult Patients: A Case Report and Review of the Literature

Background: Patent ductus arteriosus (PDA) is a congenital cardiovascular anomaly characterized by the persistent patency of the fetal ductus arteriosus after birth, resulting in left-to-right shunting and hemodynamic compromise. While PDA is common in preterm neonates, this anomaly is rare in adults and often complicated by secondary cardiac pathologies, such as valvular disease, pulmonary hypertension, and arrhythmias. Optimal management of complex adult cases requires coordinated multidisciplinary care that balances surgical and transcatheter interventions. Case: A 32-year-old male with a history of untreated PDA presented with progressive palpitations and dyspnea. A subsequent diagnostic evaluation revealed severe mitral regurgitation, mild aortic regurgitation, ascending aortic dilation, and persistent atrial fibrillation. Multimodal imaging (computed tomography (CT), transthoracic echocardiography (TTE) and electrocardiography (ECG)) confirmed a PDA measuring approximately 9–10 mm × 15 mm (by TTE) with a left-to-right shunt. The patient underwent single-stage surgical repair, including PDA double-end ligation and oversewing under TEE guidance, mechanical mitral and aortic valve replacement, modified Maze procedure, left atrial reduction, and external wrapping plasty of the ascending aorta using a #28 synthetic graft (non-Bentall). Postoperatively, the patient developed acute kidney injury, hepatic dysfunction, and sepsis, requiring continuous renal replacement therapy (CRRT), vasopressors, and targeted antibiotics. Despite complications, multidisciplinary care stabilized the patient. Conclusions: This case highlights the challenges of managing complex PDA in adults, particularly when complicated by multivalvular disease and arrhythmias. A one-stage surgical approach may reduce reoperation risks but requires vigilant postoperative monitoring for multiorgan dysfunction. Long-term follow-up with hemodynamic and imaging surveillance is essential for optimal recovery. Early identification and individualized strategy selection are crucial in high-risk adults with concomitant structural heart disease.