Anastomotic pseudoaneurysm of the ventricle after homograft placement in children.
A pseudoaneurysm of the right ventricle was diagnosed postoperatively in 8 patients between 1986 and 1992. One pseudoaneurysm formed after placement of a Carpentier-Edwards conduit and the other seven arose after placement of a homograft between the right ventricle and the pulmonary artery. Both aortic (n = 3) and pulmonary (n = 4) homografts had been used. In 6 patients, the homografts had been augmented proximally with Dacron, Gore-Tex, or pericardium. Pseudoaneurysms originated between the augmentation patch and the homograft in 4 patients, between the homograft or conduit and the myocardium in 3 patients (1 patient with and 2 without an augmentation patch), and between the patch and the myocardium in 1 patient. The prior operations performed were placement of a palliative conduit for tetralogy of Fallot with pulmonary atresia (n = 5), repair of truncus arteriosus (n = 2), and repair of absent pulmonary valve syndrome (n = 1). Pseudoaneurysms were discovered from 5 weeks to 4 years after the operation. Symptoms were present in 3 patients; in the others, diagnosis was made during follow-up on the basis of routine imaging studies. Symptoms, when present, were due to compression of surrounding mediastinal structures. Pseudoaneurysms ranged in diameter from 1.0 to 5.0 cm. Echocardiography and color-flow mapping reliably identified the pseudoaneurysm in the 6 patients in whom it was performed. Characteristic features included a well-defined, narrow aneurysm neck leading to an extracardiac echo-free space. Color-flow mapping demonstrated to-and-fro flow through the neck of the aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)
Levine
J C
JC
Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.
Mayer
J E
JE
Keane
J F
JF
Spevak
P J
PJ
Sanders
S P
SP
D017541:Aneurysm, False / Q000209:etiology*; D001011:Aorta / Q000637:transplantation*; D001807:Blood Vessel Prosthesis; D006328:Cardiac Catheterization; D002675:Child, Preschool; D006322:Heart Aneurysm / Q000209:etiology*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D010166:Palliative Care; D011183:Postoperative Complications; D019736:Prostheses and Implants; D011651:Pulmonary Artery / Q000637:transplantation*