PERCUTANEOUS CLOSURE OF A LEFT VENTRICULAR PSEUDOANEURYSM AFTER TRANSCATHETER VENTRICULAR SEPTAL DEFECT CLOSURE


Gökalp S., Ugan Atik S., Saltık İ. L.

PIC-AICS 2019 , California, Amerika Birleşik Devletleri, 4 - 07 July 2019, cilt.4, no.3, ss.143-144

  • Cilt numarası: 4
  • Doi Numarası: 10.12945/j.jshd.2019.018.19
  • Basıldığı Şehir: California
  • Basıldığı Ülke: Amerika Birleşik Devletleri
  • Sayfa Sayısı: ss.143-144

Özet

Left ventricular (LV) pseudoaneurysm is very rare in children. Untreated pseudoaneurysms lead to sudden cardiac death due to rupture. Although open surgery is conventional treatment, recently, percutaneous closure of LV pseudoaneurysms has been described. Here, we present the case of a child who underwent transcatheter ventricular septal defect (VSD) closure at 8 months who then developed a LV pseudoaneurysm,detected 16 months later, which was percutaneously closed. Case Report: A 3-month-old boy with Down syndrome diagnosed with a 5-mm apical VSD, 7-mm atrial septal defect (ASD), and patent ductus arteriosus (PDA). Five months later VSD and PDA were closed percutaneously by Amplatzer® Duct Occluder II (ADO II) device. To prevent arterial injury, an antegrade approach was performed. His postoperative course was unremarkable, echocardiography showed minimal residual shunt from the VSD. At 16 months after the initial procedure, echocardiography revealed a LV pseudoaneurysm immediately next to the ADOII device. Because the pseudoaneurysm was very close to the device, open surgery carried a high risk, so we decided on percutaneous closure. Left ventriculography demonstrated a pseudoaneurysm in the posterolateral aspect of the LV, measured 21× 17-mm with an 8-mm connecting neck. A 9-mm Amplatzer ® septal occluder (ASO), was deployed in the standard manner across the LV myocardial wall. To prevent device embolization, both discs were embedded in the pseudoaneurysm cavity. Left ventriculography confirmed total occlusion of the pseudoaneurysm. The following day, echocardiography was uneventful with complete closure of pseudoaneurysm. Three days after the procedure, pericardial effusion started and increased upto 24 mm on postoperative day 10 despite anti-inflammatory treatment. The diagnostic pericardiocentesis was unrevealing; microbiological cultures were negative. After starting steroid the patient was discharged without any effusion. An echocardiogram 2 months later showed closed VSD and pseudoaneurysm without any residual shunt. Discussion: To the best of our knowledge, this is the first case report of percutaneous LV pseudoaneurysm closure after transcatheter device closure of VSD. Even there is no direct perforation during the procedure, damage to the LV free wall by the manipulations may predisposes for pseudoaneurysm development. Time lapse between the procedure and development of pseudoaneurysm might be related with this factor. Fortunately, the patient was asymptomatic and the pseudoaneurysm was recognized incidentally. Nevertheless, we could not determine the exact time for development of pseudoaneurysm. It would likely become recognizable when large enough to be visualized on echocardiography. The rarity of this condition in children poses a challenge for treatment. Although surgery is an option, there is limited experience with high mortality rates. Transcatheter treatment is less prevalent. Device