A 92-year-old woman with a history of patent ductus arteriosus (PDA) was referred to our hospital because of worsening dyspnea, with New York Heart Association classification IV. She had 3 admissions because of congestive heart failure within a year. A 12-lead ECG showed atrial fibrillation, and a chest radiograph showed severe pulmonary congestion and cardiomegaly (Figure [A]). The plasma B-type natriuretic peptide level was 4527.9 pg/mL. The echocardiogram showed a reduced ejection fraction of 39% and moderate to severe aortic valve stenosis (peak velocity=3.9 m/s; mean pressure gradient=29 mm Hg; aortic valve area=0.83 cm²). The reconstructed 3-dimensional computed tomography (CT; Ziostation2; Ziosoft Inc, Tokyo, Japan) revealed a 50-mm thoracic aortic aneurysm and a large PDA (Krichenko type A, 4.7 mm of the pulmonary artery side) with severe calcifications surrounding it (Figure B–D; Movies I and II in the Data Supplement). Because of her refractory heart failure despite treatment with intravenous furosemide and dobutamine, we decided to perform a transcatheter occlusion of PDA 8 days after her admission to the hospital. For the transcatheter occlusion procedure, we …

由于呼吸困难加重，一位有动脉导管未闭（PDA）病史的92岁妇女被转诊到我们医院，纽约心脏协会将其分类为IV级。她一年内因充血性心力衰竭入院3次。12导联心电图显示房颤，胸部X光片显示严重的肺充血和心脏肥大（图[A]）。血浆B型利钠肽水平为4527.9 pg / mL。超声心动图显示射血分数降低39％，中度至重度主动脉瓣狭窄（峰值速度= 3.9 m / s；平均压力梯度= 29 mm Hg；主动脉瓣面积= 0.83 cm ²）。重建的3维计算机断层扫描（CT; Ziostation2; Ziosoft Inc，东京，日本）显示了50毫米的胸主动脉瘤和大型PDA（Krichenko A型，肺动脉侧4.7毫米），周围有严重钙化（图B–D；数据补充中的电影I和II）。尽管经过静脉速尿和多巴酚丁胺治疗，但由于她的顽固性心力衰竭，我们决定在她入院后第8天进行经导管的PDA闭塞术。对于经导管闭塞手术，我们…