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

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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

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Conclusion

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