Ductus arteriosus presenting as systemic and pulmonary embolism

A 52-year-old woman was admitted due to ischemic stroke treated with mechanical thrombectomy. She reported having a fever in the previous month, and a continuous systolic-diastolic murmur was identified during auscultation. An echocardiogram revealed the presence of a 7 mm x 5 mm persistent patent ductus arteriosus with hemodynamic repercussions (overload of left heart chambers) (figure 1A,B, arrow; videos 1 and 2 of the supplementary data). Additionally, a wart was found on the aortic valve with mild regurgitation. Streptococcus sanguinis was found in blood culture isolates. The thoracic coronary computed tomography angiography not only characterized the ductus, but also showed a vegetation on the pulmonary trunk, along with septic pulmonary emboli (figure 2A,D, arrow). A 4-week course of antibiotics was initiated. Due to worsening echocardiographic findings (vegetation growth, and progression of regurgitation) (figure 1C,D; videos 3 and 4 of the supplementary data), surgical intervention was decided to replace the aortic valve with a mechanical valve and close the ductus with a patch. Figure 1. Figure 2. In adults, the ductus can become calcified, thus hampering simple ligation. In this case, a small residual shunt remained, which was closed percutaneously 6 months later, following confirmation of the absence of inflammatory activity on positron emission...