A 58-year-old woman presented with progressive dyspnea. When she was 8 years old, a surgical ligation of her hypertensive patent ductus arteriosus (PDA) was performed by left lateral thoracotomy in the 4th intercostal space under general anesthesia. On this admission, 2-dimensional transthoracic echocardiography/transesophageal echocardiography (TTE/TEE) color Doppler showed dilated left atrium, mildly hypertrophied left ventricle with an ejection fraction of 58% with impaired relaxation; parasternal short axis and suprasternal views showed an enlarged main pulmonary artery and a mild left-to-right shunt via a distorted PDA. Right heart catheterization demonstrated a systolic pulmonary artery pressure of 35 mmHg and a pulmonary flow/systemic flow of 1.1:1. After heart team discussion, a catheter-based treatment was confirmed. Percutaneous closure was performed under local anesthesia and fluoroscopic guidance. Aortic arch angiograms showed an elongated ductus with constriction on the left pulmonary artery opening (type E according to classification of Krichenko) (Figure 1, Supplementary Video 1).1) A retrograde approach for crossing the residual PDA was chosen. A 4-Fr compatible 6-mm vascular plug system (Cera; Lifetech Scientific, Shenzhen, China) (Figure 2) was selected for implantation and successfully deployed with abolition of residual shunting (Supplementary Videos 2, 3). The patient was discharged without complications the following day. At 1-month follow-up she remained symptom free and TTE did not demonstrate any residual shunt flow.