A 10-month old, ex 29-week gestation infant attends general paediatric clinic. She is 2 months post-transcutaneous occlusion of a large patent ductus arteriosus (PDA) with a 10×8 ADO1 Amplatzer device; she weighed 5 kg at the time of procedure and was in clinical heart failure due to the large left-to-right shunt. At the time of procedure, it was noted that the device could lead to aortic obstruction. Discussion between the interventional and cardiothoracic determined that the position of the device was acceptable and that removal may exacerbate her heart failure. At discharge after the procedure, aortic occlusion by the device with time was highlighted as a risk, hence close follow-up was recommended. The patient had remained well since the procedure.

On examining the patient, you find her mildly tachypnoeic (respiratory rate 50 BPM), with bilaterally equal air entry and saturations of 95%. She has a 2/6 ejection systolic murmur, which radiates to the back, both femoral pulses are difficult to palpate. …