‘Asthma’ cured after cardiac surgery

Abstract

Asthma' cured after cardiac surgeryA 6-year-old boy, with no relevant medical history, was seen for recurrent dyspnoea and wheezing. He was found to have a systolic heart murmur. An echocardiogram showed a circular anechogenic image posterior to, and to the left of, the ascending aorta, compressing the pulmonary trunk and right pulmonary artery, with systolic fl ow into the lesion.An MRI and multidetector helical CT scan (fi gure 1) revealed a saccular calcifi ed aneurysm (56×36 mm) communicating with the ascending aorta and compressing the left main bronchus and trachea.Angiography showed a dominant right coronary artery with compression and retrograde fi lling of the left coronary. A myocardial perfusion scan revealed reversible perfusion defects in the apex and lateral wall.Surgical resection and a coronary artery bypass graft were performed. The pathological examination revealed an aortic pseudoaneurysm that was fi brosed and partially calcifi ed (fi gure 2).Four years after surgery, the patient is clinically well, without further episodes of dyspnoea or wheezing.Aortic aneurysms and pseudoaneurysms are very rare in children. 1 Many patients present with non-specifi c physical fi ndings or symptoms. Our patient presented with dyspnoea and wheezing. Sometimes the fi rst signs are caused by aneurysm rupture. 2 3 If suspected, the best imaging modalities for diagnosis are MRI or a CT scan. 2 Pseudoaneurysms are most commonly associated with trauma or infection. 1-4 Our patient had no history of trauma or infection, so the aetiology remains unknown. Surgical resection and vessel reconstruction were effective, preventing a catastrophic outcome. Figure 1 (A) MRI scan revealing the aneurysm location (arrows). (B) CT scan showing a saccular calcifi ed aneurysm (arrows) communicating with the ascending aorta (Ao).Figure 2 Macroscopic image of the excised aneurysm, with multiple small thrombi attached to the wall. group.bmj.com on June 15, 2015 -Published by REFERENCES 1. Guzzetta PC. Congenital and acquired aneurysmal disease. Semin Pediatr Surg 1994;3:97-102. 2. Hiratzka L, Bakris G, Beckman J, et al. 2010 Guidelines on thoracic aortic disease. Circulation 2010;121:266-369. 3. Shrivastav V, Vaideeswar P, Jana S, et al. Aortic pseudo-aneurysm: cause of life-threatening hemoptysis in a 13-month-old child. J Card Surg 2008;23:553-5. 4. Barth H, Moosdorf R, Bauer J, et al. Mycotic pseudoaneurysm of the aorta in children.