Persistent ductus arteriosus in old patient with atrial fibrillation

Persistent ductus arteriosus is a congenital cardiovascular malformation usually diagnosed in early childhood by echocardiography and cardiac catheterization. Computed tomography and cardiac magnetic resonance are excellent, noninvasive methods and are recommended when additional quantification of RV, LV, shunt a or PAH is required. We present a case of an 86-year-old woman with symptoms of a continuous murmur, heart failure (shortness of breath and fatigue) and atrial fibrillation. The 24-hour-monitoring of the electrocardiogram showed the average heart rhythm 69bpm and with 80 pauses above 2.0 seconds which were asymptomatic. Echocardiography showed features of pulmonary hypertension. Computed tomography excluded pulmonary embolism but suggested the suspicion of persistent ductus arteriosus. To find the cause of pulmonary hypertension, a magnetic resonance was performed which showed persistent ductus arteriosus. A treatment with ACE inhibitors, rivaroxaban, etc. was applied. Due to the clinical status of the patient and the lack of consent for PDA closure, a conservative treatment was proposed. Congenital heart disease in elderly patients is challenging. Cardiac magnetic resonance imaging is non-invasive and quantifies accurately the cause of pulmonary hypertension in elderly patients with an undiagnosed congenital heart disease. Furthermore, it can be safely performed to monitor pulmonary hypertension without the risk of ionizing radiation.