Lethal recurrent mycotic ascending aortic pseudoaneurysm in a 21-month-old child with repaired subaortic membrane

Abstract

Mycotic pseudoaneurysm of the aorta is a rare and lethal complication of pediatric congenital heart surgery. We report the lethal consequences of recurrent mycotic pseudoaneurysm in an 18-month-old baby, early after subaortic membrane resection. We managed to repair the pseudoaneurysm successfully by replacing the infected ascending aorta using bovine jugular vein graft, but unfortunately, the patient developed new pseudoaneurysm at the site of anastomosis which led to his death. Although prompt diagnosis and surgical management can save the patient life, uncontrolled infection can lead to the recurrence of the problem and lethal results.

Aortic Pseudoaneurysm following Ventricular Septal Defect Closure in a Pediatric Patient: A Case Report and Literature Review

“…Once the diagnosis of aortic pseudoaneurysm is confirmed, surgery is indicated since spontaneous bleeding complications can be fatal. However, some surgeons may prefer to perform surgery after a course of antibiotic treatment [ 10 ]. Standard treatment for aortic pseudoaneurysm in children has not been clearly defined, but surgical repair and interventional approaches are the main options.…”

Ascending aortic pseudoaneurysm presenting as heart failure in a child – A rare complication associated with coronavirus disease 2019

“…The common etiological causes are postcardiac surgery, mycotic aneurysm, or blunt chest trauma. [ 4 5 ] These patients may be asymptomatic in small rupture to acute presentation in larger defects. Our patient had presented with gross CHF due to ventricular dysfunction.…”

“…[ 2 3 ] Aortic pseudoaneurysm presenting as congestive heart failure (CHF) in children is rare and usually due to mycotic aneurysm, followed by cardiac surgery or blunt chest trauma. [ 4 5 ] COVID-19-producing aortic pseudoaneurysm is not known, and multiple mechanisms play a role in the pathological process. Platelet aggregation, thrombotic occlusion of vasa vasorum, activation of the complement system or secondary bacterial or fungal infection leading to necrosis, and rupture of the aorta are some possible hypotheses of pseudoaneurysm of the aorta.…”

A large mycotic pseudo-aneurysm of ascending aorta after mitral valve replacement: - the Tinderbox

“…This was accomplished by deep hypothermic circulatory arrest and femoral cardiopulmonary bypass, even carotid cannulation for cardiopulmonary bypass and femoro-femoral bypass under Moderate hypothermia with transient circulatory arrest has been used (1,18). Ascending aortic aneurysm also has been reported following cardiac transplantation (19).The Repair of recurrent mycotic pseudoaneurysm in an 18-month-old baby, early after subaortic membrane resection has been reported, by replacing the infected ascending aorta using bovine jugular vein graft (20). Most appropriate therapy if a mycotic pseudoaneurysm involves the ascending aorta is replacement of the aorta with a homograft which is a lengthy and more complicated procedure.…”