Abstract
Pseudoaneurysm of the right ventricle outflow tract (RVOT) is a rare complication
in pediatric cardiac surgery. We report a patient who developed a right ventricular
pseudoaneurysm 8 months after RVOT enlargement using a pericardial patch for infundibular
pulmonary stenosis. Our patient was born with severe pulmonary valvular stenosis and
treated with percutaneous balloon valvotomy in the neonatal period. Six months later,
she developed infundibular pulmonary stenosis, which required surgical resection of
right ventricle infundibular trabeculations and bovine pericardial patch enlargement.
The postoperative period was normal. She was readmitted to hospital 5 months later
complaining of wheezing, coughing and shortness of breath. Echocardiography showed
a huge aneurysmal dilatation of the outflow patch in connection with the right ventricular
cavity. The patient underwent resection of the pseudoaneurysm and former patch, followed
by interposition of a bovine jugular vein conduit between the RVOT and pulmonary bifurcation.
The early postoperative period was uncomplicated. On echocardiography, no significant
residual gradient was measured through the conduit and there was no insufficiency
of the valve. RVOT reconstruction with patch enlargement, homograft or conduit implantation
can be the origin of pseudoaneurysms. Although their incidence is rare, they are often
asymptomatic before becoming quite large and causing compression symptoms as in our
patient with respiratory complaints due to airway compression. It is important to
follow up these patients closely, especially in the first year after surgery since
most aneurysms develop within 6 months of surgery.
Key words
Cardiovascular surgery - heart disease - heart valve surgery
References
- 1
Rosental A, Gross E, Pasternac A.
Aneurysms of right ventricular outflow patches.
J Thorac Cardiovasc Surg.
1972;
63
735-740
- 2
Levine J C, Mayer J E, Keane J F, Spevak P J, Sanders S P.
Anastamotic pseudoaneurysm of the ventricle after homograft placement in children.
Ann Thorac Surg.
1995;
59
60-66
- 3
Calabro R, Santoro G, Pisacane C, Pacileo G, Giovanna R, Vosa C.
Repeat syncopal attacks due to postsurgical right ventricular pseudoaneurysm.
Ann Thorac Surg.
1999;
68
252-254
- 4
Tirado A M, Santos de Soto J, Camacho J G, Madrid A A, Fournier M G, Senorans A D.
Postsurgical pseudoaneurysm of the right ventricular outflow tract.
Rev Esp Cardiol.
2005;
58
313-315
- 5
Tiete A R, Sachweh J S, Roemer U, Kozlik-Feldmann R, Reichart B, Daebritz S H.
Right ventricular outflow tract reconstruction with the Contegra bovine jugular vein
conduit: a word of caution.
Ann Thorac Surg.
2004;
77
2151-2156
- 6
Pillai S K, Reddy H P S, Kulkarni S, Murthy K S, Cherian K M.
Pseudoaneurysm of homograft placed in right ventricular outflow tract.
Ann Thorac Surg.
2004;
78
1068-1070
- 7
Murashita T, Hatta E, Imamura M, Yasuda K.
Giant pseudoaneurysm of the right ventricular outflow tract after repair of truncus
arteriosus: evaluation by MRI imaging and surgical approach.
Eur J Cardiothorac Surg.
2002;
22
849-851
- 8
Yeo T C, Malouf J F, Seward J B.
Clinical profile and outcome in 52 patients with cardiac pseudoaneurysm.
Ann of Inter Med.
1998;
128
299-305
Dr. Mustafa Cikirikcioglu, MD
Department of Cardiovascular Surgery
University Hospital of Geneva
24 Rue Micheli Du Crest
1211 Geneva
Switzerland
Phone: +41 7 65 35 10 84
Fax: +41 2 23 72 76 35
Email: mustafa.cikirikcioglu@hcuge.ch
