Cardiac and great vessels pseudoaneurysms and their challenging options of the management in children

Abstract

Introduction: Cardiac and great vessel pseudoaneurysms are often difficult to diagnose and might be easily missed. Delay in diagnosis and management may lead to serious event. Case Series: We are presenting three cases with huge pseudoaneurysms. The clinical approach, diagnostic imaging, and challenging options of management were illustrated. The first case was 12 years old girl presented with clinical features of bacterial endocarditis; echocardiography showed multiple vegetations on mitral valve (MV). She underwent cardiac surgery with removal of vegetation and repair of MV. Three weeks later an echocardiogram revealed a large left ventricle (LV) lateral wall pseudoaneurysm. She underwent aneurysmectomy and repair of LV lateral wall. Second case, a 3 years old girl with history of fever for one month. Echocardiography showed LV pseudoaneurysm and huge pericardial effusion. The pseudoaneurysm entrance was closed percutaneously. The third case was 3-months baby girl diagnosed with aortic coarctation (COA), patent ductus arteriosus (PDA), and muscular ventricular septal defect. She has repair of COA, pulmonary artery band (PAB), and PDA ligation at three weeks of age. Six weeks later developed sepsis. Echocardiography and CT revealed huge pseudoaneurysm at site of COA repair. Surgical resection of the huge pseudoaneurysm was done. Conclusion: Meticulous evaluation and good utilization of the cardiac diagnostic tools will result in early diagnosis and management of the cardiac and vessel pseudoaneurysms which are usually fatal.