Journal of JCIC

We report a case of a 35-year-old male with a history of patent ductus arteriosus (PDA) treated with a Rashkind PDA occlusion system during infancy, who presented in adulthood with an enlarged residual shunt. Despite being asymptomatic, follow-up echocardiography revealed left ventricular dilation and an increased Qp/Qs ratio, prompting further investigation. Cardiac catheterization confirmed PDA with hemodynamic significance, leading to a decision for reintervention. Transcatheter closure was successfully performed using an Amplatzer Duct Occluder II(ADOII), carefully avoiding interference with the existing Rashkind device. Post-procedural imaging confirmed complete closure without residual leak. The patient experienced no complications and was discharged on the third day after the procedure. At six-month and 11-month follow-ups, left ventricular end-diastolic diameter had improved, and no recurrence of shunt was observed. This case underscores the importance of long-term follow-up in patients with prior PDA closure, especially those with residual shunts. Even PDA may warrant reevaluation and intervention due to potential progressive cardiac remodeling. Furthermore, the case highlights the efficacy and safety of ADO II in a “device-in-device” strategy for residual PDA. It also suggests that late reintervention should not be regarded as a failure of initial therapy, but rather as an adaptive response to long-term anatomical and hemodynamic changes.