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A one-year-old boy with repaired tetralogy of Fallot presented with recurrent fever. Blood cultures grew Streptococcus mitis/oralis, but transthoracic echocardiography showed no infective endocarditis. Cardiac CT angiography revealed an occult right ventricular outflow tract pseudoaneurysm, which was surgically resected. This case highlights CT angiography as a critical diagnostic tool when echocardiography fails to identify infectious sources in CHD.
A 7-year-old boy with a history of fish bone ingestion presented with a progressively enlarging, painless right-sided neck mass one year after the initial event. Contrast-enhanced CT angiography revealed a giant 5 × 5 cm pseudoaneurysm originating from the right common carotid artery. Surgical treatment consisted of complete excision of the pseudoaneurysm followed by primary end-to-end arterial anastomosis. The patient was extubated on postoperative day one and discharged on day five without neurological deficits. At two-year follow-up, Doppler ultrasonography demonstrated durable patency of the anastomosis with no evidence of recurrence or stenosis. An intraoperative surgical video demonstrating aneurysm excision and primary end-to-end repair is provided as supplementary material. This case highlights the importance of considering vascular injury in children presenting with delayed neck masses after foreign body ingestion and supports primary end-to-end repair as a safe surgical option in selected paediatric patients.
We report a 7-year-old boy with tetralogy of Fallot who developed a right ventricular pseudoaneurysm one year after right ventricular outflow tract reconstruction with a 17 mm pulmonary homograft. Urgent reoperation revealed proximal homograft dehiscence. Repair was performed using an Invengenx® pericardial patch. This rare complication highlights the importance of long-term surveillance following homograft implantation in congenital heart surgery.
Vascular access-related complications are an important consideration in patients undergoing cardiac catheterisation. Patients with CHD are increasingly undergoing percutaneous treatment for suitable procedures as an alternative, less invasive option to surgical intervention. As such, recognition and treatment of these complications are becoming increasingly important. We present a case of a patient with repaired Tetralogy of Fallot who developed a femoral arteriovenous fistula and femoral artery pseudoaneurysm arising from an accessory arterial branch following percutaneous Harmony valve implantation, both of which were treated endovascularly with placement of a stent.
Cardiac myxoma is a relatively rare tumour, usually solitary, that occurs primarily in the left atrium of adults, but comprises only 30% of cardiac tumours in children. We recently treated a 12-year-old girl with multiple recurrent myxomas in three cardiac chambers(following surgical resection 3 years earlier). Genomic analysis showed the PKAR1A mutation typical for Carney complex
The carotid artery is a valuable vascular access that can be used in patients who have undergone repetitive interventional and surgical procedures and premature babies. In the past, cut-down was used but nowadays, mostly the procedure is performed under ultrasonographic guidance. Complications such as bleeding, haematoma, and pseudoaneurysm may occur when the carotid artery is used as a vascular access for the procedures such as aortic balloon valvuloplasty, coarctation balloon angioplasty, or after interventional or surgical treatments to the carotid artery. Although pseudoaneurysm is very rare, prompt diagnosis and accurate treatment planning are life-saving. In this article, the diagnosis and treatment of pseudoaneurysm in the left common carotid after transcatheter coarctation balloon angioplasty in a 6-month-old infant will be presented.
Pulmonary artery pseudoaneurysms are uncommon. They may occur secondary to trauma, infectious diseases, vasculitis syndromes, neoplasms, congenital diseases, and pulmonary hypertension. Due to increasing number of cardiac interventions, iatrogenic complications are among the major causes of pulmonary artery pseudoaneurysms.
In this report, we present a 6-month-old patient with pulmonary pseudoaneurysm that occurred following pulmonary balloon angioplasty for the relief of a pulmonary band.
We present a case of percutaneous closure of main pulmonary artery pseudoaneurysm using an atrial septal occluder device in a seven-month-old infant. The infant had tetralogy of Fallot repair followed by transcatheter left pulmonary artery stenting. The occlusion of the wide neck of the pseudoaneurysm was performed successfully using the atrial septal occluder with no detected complications in his six-month follow-up post-catheterisation.
Pseudoaneurysms of the ascending aorta are rarely seen in paediatric patients. They may occur following complex cardiovascular surgery and are associated with a high risk of mortality due to their nature of spontaneous rupture. In this case report, we discuss a 1-year-old paediatric patient with an ascending aortic pseudoaneurysm following Norwood Stage 1 surgery with Sano modification for hypoplastic left heart syndrome and the patient’s successful recovery following aneurysmectomy with Norwood Stage 2 operation.
Pseudoaneurysm of the ascending aorta is rare (1–2%) and a potentially fatal complication following cardiac surgeries. Surgical repair is still the gold standard treatment of ascending aortic pseudoaneurysm. However, endovascular repair methods including stent grafts and Septal Occluder devices have been reported. We report a case of 38-year-old female patient who presented with giant ascending aortic pseudoaneurysm, and aortopulmonary fistula 22 years after modified BlalockTaussig shunt was managed by the transcatheter method. Septal Occluder device 20 mm diameter was delivered to seal the ostium.
Post-procedural right ventricular pseudoaneurysm is a rare but life-threatening complication of interventional catheterisation. We describe a 3-day-old newborn who underwent transcatheter intervention for pulmonary atresia with a complication of right ventricular pseudoaneurysms, and transcatheter embolisation of the pseudoaneurysms was performed at 3-week-old. It is the first described case that receives transcatheter closure of right ventricular pseudoaneurysms in a newborn with a favourable outcome.
We report a case of an isolated congenital right ventricular outpouching detected incidentally on foetal echocardiogram that was performed due to suspicion of CHD. Subsequent echocardiogram after birth revealed an aneurysm with features of a pseudoaneurysm having a thin and hypokinetic wall connected to the ventricleʼs cavity via a narrow neck. This pseudoaneurysm appears to be stable in size and of no clinical significance during the short-term follow-up.
Carotid artery aneurysm is a potentially fatal complication of skull base osteomyelitis. It is important to know the warning signs for this complication, as early diagnosis is of great importance. This report aimed to determine whether the pattern of cranial nerve involvement may predict the occurrence of aneurysm involving the internal carotid artery in skull base osteomyelitis.
Methods
Two diabetic patients with skull base osteomyelitis were incidentally diagnosed with pseudo-aneurysm of the petrous internal carotid artery on follow-up magnetic resonance imaging. They presented with lower cranial nerve palsy; however, facial nerve function was almost preserved in both cases. Computed tomography angiography confirmed aneurysms at the junction of the horizontal and vertical segments of the petrous carotid artery.
Results
Internal carotid artery trapping was conducted using coil embolisation. Post-coiling magnetic resonance imaging demonstrated no procedure-related complications. Regular follow up has demonstrated that patients’ symptoms are improving.
Conclusion
One should be mindful of this potentially fatal complication in skull base osteomyelitis patients with lower cranial nerve palsies, with or without facial nerve involvement, especially in the presence of intracranial thromboembolic events or Horner's syndrome.
Left ventricular outflow tract pseudoaneurysms are a rare but life-threatening disorder, often caused by complications of cardiac surgery or myocardial infarction. We present a case report of a patient with no prior risk factors who presented with a six-month history of progressive exertional dyspnea, bilateral leg swelling and cough. Point-of-care ultrasound revealed an unexpected outpouching of the left ventricle. He was diagnosed with a left ventricular outflow tract pseudoaneurysm and subsequently went into cardiogenic shock secondary to extension of pseudoaneurysm causing extrinsic compression of the coronary arteries. The patient underwent successful emergency surgical repair and made a full recovery.
The mitral–aortic intervalvular fibrosa is an area of fibrous continuity between the mitral and aortic valves. We present the first case of a congenital pseudoaneurysm in this region, detected prenatally as an isolated cardiac defect, which was followed-up conservatively postnatally. The diagnosis was confirmed by echocardiogram demonstrating blood flow into the pouch during systole and into the left ventricular outflow tract during diastole. The infant has been followed-up with serial echocardiograms demonstrating stable size and appearance of the lesion, without signs of obstruction, making close continued observation a reasonable approach.
We present the case of a 23 year-old male who sustained an anterior tibial artery pseudoaneurysm after an apparently innocuous soccer injury. The patient presented with sudden onset severe pain and swelling one week after the injury. The diagnosis was made using duplex ultrasound, and confirmed with CT angiography. Definitive management consisted of endovascular platinum microcoiling. One year later, the patient is asymptomatic and remains active. A review of the epidemiology, diagnosis, and treatment of arterial pseudoaneurysm is presented. Bedside ultrasound in the emergency department may be a useful adjunct in the early identification of pseudoaneurysms.
This case report documents the successful surgical repair of an aorto-bronchial fistula and a giant aortic pseudoaneurysm at the proximal anastomosis of a dacron interposition tube graft that was balloon dilated for recurrent coarctation. Balloon dilation for recoarctation of a dacron interposition tube graft may lead to serious complications.
Post-infective pseudoaneurysm of the left ventricle in children is very rare, with only five cases reported in English medical literature so far. Patients usually have a short history of infection by Staphylococcus aureus. Timely surgical intervention has generally a good outcome. We present a case of post-infectious pseudoaneurysm in a 2-year-old girl with a review of literature.
A 25-year-old male developed a traumatic intimo-medial dissection and saccular pseudoaneurysm at the origin of the innominate artery following a motorcycle accident. On physical examination there was no perceivable trauma to the chest. In addition, there were no clinical symptoms that suggested this serious injury. The patient was managed with successful stent-graft placement on an elective basis.
AzarconF, GhalebM. Early Diagnosis and Treatment of a Posttraumatic Pseudoaneurysm/Dissection of the Innominate Artery. Prehosp Disaster Med. 2014;29(1):1-3.