Pseudoaneurysm after Tetralogy of Fallot Repair Using Right Ventricular Outflow Tract Patch

Abstract

Background: Pseudoaneurysm complicating right ventricular outflow tract (RVOT) with conduit placement was an infrequent complication but with potential for significant morbidity and mortality, and a more unusual pseudoaneurysm after RVOT patching was investigated here. Methods: Patients diagnosed as pseudoaneurysms at our institution from 2010 to 2019 were reviewed and their clinical characteristics were analyzed. Results: A total of seven patients developed pseudoaneurysm in RVOT were identified. One pseudoaneurysm arose after placement of a conduit between the right ventricle and the pulmonary artery, and the other six formed after RVOT patching. One patient presented with arrhythmia, one patient had the pseudoaneurysm discovered after the diagnosis of subacute infective endocarditis and mediastinal infection, another patient was diagnosed during the operation for relief of anastomotic stenosis, and the other four patients were diagnosed during follow-up. Three patients had a RVOT pressure gradient immediately postoperatively and a progressive elevation, and another two patients presented with new emergence of RVOT pressure gradient at the discovery of pseudoaneurysm. A new mass in the left superior mediastinum on chest X ray film was showed in 5 patients. The pseudoaneurysm was surgical resected successfully with an uneventful recovery course and without relapse in six patients, and the other one caused by infection was still in a strict followup. Conclusion: The increasing elevation or new emergence of RVOT pressure gradient and radiological abnormality with a new mass in superior mediastinum are probable evidences for pseudoaneurysm formation after RVOT patch repair, and the clinicians should pay special attention to patients when indicated.