Adult patent ductus arteriosus: successful surgical therapy in a rare presentation of a missed finding.

Delayed clinical presentation of patent ductus arteriosus (PDA) in adults is very rare. The clinical presentation in adults consists of either aortic or pulmonary valve endocarditis. We report the case of 34-year-old patient with a known history of rheumatic heart disease in childhood and chronic heart failure for 5 years who presented with acute heart failure and no evidence of PDA at prior echocardiography. Blood cultures grew Staphylococcus epidermidis, and echocardiography showed infective endocarditis of both aortic and pulmonary valves in the context of a large and severely inflamed PDA. Cardiopulmonary bypass and deep hypothermic circulatory arrest were used to interrupt the PDA from within the pulmonary artery because of inability to ligate the severely inflamed and calcified PDA prior to bypass. Combined pulmonary and aortic valve replacement and high-dose inotropic support were used. Dialysis was used for renal failure. The patient recovered and was discharged 10 days postoperatively. Six months later the patient was asymptomatic, and renal failure had resolved. The history and surgical management are discussed with an updated review of the literature.