Percutaneous endovascular management of ascending aortic pseudoaneurysm after heart transplantation in a pediatric patient

Abstract

Ascending aortic pseudoaneurysm is a rare complication after HT. Surgery is the most conventional management, but in some patients, it is risky. We report the case of a ten-year-old child who underwent HT and developed an ascending aortic pseudoaneurysm in the aortic anastomosis. He was successfully treated with two covered stents through endovascular management. Endovascular therapy is an alternative management in high-risk patients. To our knowledge, this is the first report about endovascular therapy of an AAP after HT in a pediatric patient.

Pseudoaneurysm of the ascending aorta: case report of a donor-derived Pseudomonas infection in a heart transplant recipient

“…4 ). Resected specimen of ascending aortic pseudoaneurysms of heart transplant patients frequently grows Staphylococcus aureus [ 4 – 17 ], P. aeruginosa [ 7 , 14 , 18 – 23 ] or Candida species, [ 7 , 14 , 21 , 24 – 29 ] but other gram-positive [ 7 , 14 , 30 , 31 ] or gram-negative [ 14 , 32 ] bacteria and Aspergillus fumigatus [ 33 – 35 ] are also reported as potential pathogens.

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“…The following predisposing factors for aortic wall infection and formation of mycotic pseudoaneurysm are documented in literature: intrathoracic infection (50%) [ 6 – 8 , 10 , 14 – 16 , 24 , 25 , 30 , 33 , 35 , 36 ], pneumonia or bronchitis (20%) [ 4 , 13 , 17 , 19 , 21 , 25 , 26 ], heart–lung transplantation (17.5%) [ 4 , 14 , 15 , 19 , 25 ], reoperation due to bleeding (15%), [ 4 , 8 , 13 , 31 ] diabetes mellitus (15%), [ 7 , 12 , 15 , 31 , 35 , 37 ] infection of a previous ventricular assist device (12.5%) [ 9 , 14 , 22 , 23 ], transmission of microorganisms from the donor (7.5%) [ 8 , 25 ], acute cholecystitis (5%) [ 28 , 33 ], urinary tract infection (5%) [ 18 , 31 ], other septicaemia (5%), [ 17 , 21 ] pacemaker endocarditis (2.5%), [ 13 ] skin disruption (2.5%), [ 29 ] heart–lung retransplantation (2.5%) [ 25 ].…”

“…Possible symptoms of mycotic aortic pseudoaneurysms are malaise [ 4 , 18 , 22 , 28 ], chest [ 6 , 8 , 10 , 12 , 28 , 32 ] or back pain [ 6 , 19 , 23 , 33 ], dyspnea [ 17 , 25 , 27 , 30 ], hoarseness [ 21 , 30 ] or fever [ 4 , 6 , 8 , 9 , 12 , 13 , 17 – 19 , 22 , 23 , 27 , 31 – 33 ]. However, completely asymptomatic cases are also reported [ 25 , 26 , 34 , 37 ].…”

“…Early diagnosis, surgical intervention and adjuvant antibiotic therapy seem to be the keys to successful management of mycotic pseudoaneurysms after HTX. Based on literature data of heart transplant patients with ascending aortic mycotic pseudoaneurysms with a median follow-up time of 8 months after diagnosis, almost two-thirds of patients recovered after operation [ 4 – 7 , 9 , 10 , 13 – 15 , 17 , 21 , 23 , 24 , 26 – 32 , 34 , 35 , 37 ], a sixth of them died due to pseudoaneurysm [ 4 , 6 , 8 , 14 , 16 , 25 , 33 ], and an eighth of them presented with a recurrent pseudoaneurysm later [ 7 , 8 , 12 , 19 – 21 ]. Median time between first surgical treatment for pseudoaneurysm and the verification of recurrence was 2 months.…”

Heart transplantation at the Peruvian National Heart Institute: One-decade single-center experience

“…The early complications were considered during the first 72 hours postoperative and the late after that period. During follow-up, three patients developed arterial hypertension, three diabetes mellitus, and 1 case of ascending aortic pseudoaneurysm in a child treated successfully with an endovascular stents placement (12). Neoplasms were not documented.…”