Dysfunctional pulmonary artery conduit and co-existing large pseudoaneurysm: well-suited for a percutaneous approach with the Melody valve?

Rouven Kubicki,Brigitte Stiller,Jochen Grohmann

doi:10.1186/s40064-016-3273-3

Abstract

Pseudoaneurysm formation is a rare but potentially life-threatening complication after surgical repair of congenital heart disease. We present a boy with truncus arteriosus communis 14 years after homograft placement in pulmonary position. On follow-up, he presented progressive chronic homograft degeneration. Moreover, a large pseudoaneurysm in the right ventricular outflow tract was surprisingly depicted. We opted for a two-stage interventional approach.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-3273-3) contains supplementary material, which is available to authorized users.

Highlights

Pseudoaneurysm of the right ventricular outflow tract (RVOT) is a rare complication after surgery for congenital heart disease
We report on a two-stage interventional approach for valve replacement in a degenerated right ventricular-topulmonary artery (RV-PA) homograft by percutaneous pulmonary valve implantation (PPVI) and exclusion of a large co-existing pseudoaneurysm
As the pseudoaneurysm originates from the right ventricular outflow tract and lies just behind the sternum, there is the risk of bisecting during sternotomy

Summary

Background

Pseudoaneurysm of the right ventricular outflow tract (RVOT) is a rare complication after surgery for congenital heart disease. We report on a two-stage interventional approach for valve replacement in a degenerated right ventricular-topulmonary artery (RV-PA) homograft by percutaneous pulmonary valve implantation (PPVI) and exclusion of a large co-existing pseudoaneurysm. Cardiac MRI revealed a pulmonary regurgitant fraction of 50 %, end-diastolic volume of 134 ml/m2, dilation of the non-calcified homograft up to 18–24 mm, and a large pseudoaneurysm distal to the homografts valve (Additional file 2: Figure S1). This aneurysm had a short neck with a narrow ostium. Final hemodynamic assessment demonstrated significant improvement and normal RV pressure These findings remained stable during 3 year follow-up. There is no echocardiographic evidence of the valve’s mechanical dysfunction

Discussion

Conclusion