Case Report Coarctation of the Aorta as a Complication of Surgical Ligation of Patent Ductus Arteriosus in a Premature Infant Amna Qasim, 1 Soham Dasgupta, 1 Sunil K. Jain, 2 Amyn K. Jiwani, 3 and Ashraf M. Aly 3 1 Department of Pediatrics, University of Texas Medical Branch, Galveston, TX 77550, USA 2 Department of Neonatology, University of Texas Medical Branch, Galveston, TX 77550, USA 3 Department of Pediatric Cardiology, University of Texas Medical Branch, Galveston, TX 77550, USA Correspondence should be addressed to Soham Dasgupta; dasguptasoham@gmail.com Received 16 February 2017; Accepted 2 March 2017; Published 13 March 2017 Academic Editor: Bernhard Resch Copyright © 2017 Amna Qasim et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Surgical ligation of a patent ductus arteriosus (PDA) is a commonly performed procedure. Complications are infrequent and most commonly include recurrent laryngeal nerve injury and rarely ligation of lef pulmonary artery. We report a case of accidental ligation of the descending thoracic aorta leading to a clinically signifcant coarctation. 1. Introduction Surgical ligation of patent ductus arteriosus (PDA) is a com- monly performed procedure with infrequent complications such as pneumothorax, tears in the ductus arteriosus or the aorta, wound infections, injury of the recurrent laryngeal nerve, and ligation of the lef main bronchus or the lef pulmonary artery [1]. We report the frst known case of accidental clipping of the descending aorta leading to a clinically signifcant coarctation during a surgical ligation of a PDA. 2. Case Presentation A premature female infant born at 32 weeks weighing 1,410 grams had a complicated neonatal course that included res- piratory distress requiring mechanical ventilation and necro- tizing enterocolitis that required exploratory laparotomy and bowel resection. A long systolic murmur was heard at 2 weeks of life. An echocardiogram revealed a large PDA (lef to right shunt), mild lef atrial and lef ventricular dilation, and a normal aortic arch. Te baby was treated with 2 courses of indomethacin without any response. A chest X-ray showed cardiomegaly and pulmonary congestion consistent with congestive heart failure. Since the patient failed decongestive therapy, surgical ligation of the PDA was performed on day 18 of life. A lef posterolateral approach was used and the aortic arch, descending aorta, lef subclavian artery, vagus nerve, recurrent laryngeal nerve, and PDA were all reported to be visualized clearly. Te PDA was ligated with a 10mm clip afer ensuring adequate pre- and postductal saturations. Te patient was subsequently noted to have a loud ejection systolic murmur. Te blood pressure in the upper extrem- ities was noted to be higher than in the lower extremities (91/65 mmHg versus 77/45 mmHg, resp.). A repeat echocar- diogram demonstrated juxtaductal coarctation of the aorta due to impingement of the PDA clip on the descending thoracic aorta (Figure 1 versus Figure 2). Te peak velocity was 4.1 m/sec and the peak gradient was 68 mmHg. Afer extensive discussion with the surgical team, it was decided to monitor the patient clinically with the anticipation that she may need surgery if her condition deteriorates. Follow-up echocardiograms demonstrated depression of the lef ventric- ular systolic function (shortening fraction down to 17%) with dilation of both lef atrium and ventricle. At that point, surgi- cal intervention was deemed necessary and the coarctation was corrected with a patch repair technique. Postsurgical echocardiograms revealed improvement in cardiac function (shortening fraction 27–29%) and no residual coarctation. Hindawi Case Reports in Pediatrics Volume 2017, Article ID 2647353, 3 pages http://dx.doi.org/10.1155/2017/2647353