Ramya Deepthi Billa, MBBS
University of Iowa Stead Family Children's Hospital
Iowa City, IA
Disclosure information not submitted.
Yezan Abderrahman, MD
Pediatric Critical Care Fellow
University of Iowa Hospital and Clinics
Iowa City, IA, United States
Disclosure information not submitted.
Madhuradhar Chegondi, MD
Clinical Associate Professor, Division of Pediatric Critical Care Medicine
University of Iowa Stead Family Childrens's Hospital
Iowa City, IA, United States
Disclosure information not submitted.
Title: Ventricular Pseudoaneurysm Complicating Infective Endocarditis in a Child with Taussig-Bing Anomaly
Case Report Body
Introduction: Ventricular pseudoaneurysms are rare and can occur due to infection, trauma, ischemia, or cardiac surgery. They present with non-specific symptoms; however, asymptomatic in most cases. Pseudoaneurysms can lead to thromboembolism, rupture, and death. We present an infant with repaired Taussig-Bing anomaly with right ventricular (RV) pseudoaneurysm secondary to infective endocarditis (IE).
Case Description: 11-month old male infant with Taussig-Bing anomaly (Double outlet right ventricle, malposed great vessels, subpulmonic VSD) underwent a staged repair including balloon atrial septostomy and PDA stent in the newborn period; followed by full intracardiac repair at 6 months of age with VSD closure via LV to aorta baffle, 14 mm RV to PA conduit with PA homograft, left pulmonary artery resonctruction, PDA closure, and partial closure of ASD. He was admitted at 9 months of age with IE due to Streptococcus mitis. Transthoracic echocardiogram showed tricuspid valve vegetation. His fever persisted with increased vegetation size despite Ceftriaxone therapy, and he underwent surgical removal of the vegetations on hospital day (HD) 14. On HD 39, he developed fever and decreased activity. His chest X-ray revealed a protrusion from the left upper border of the cardiac silhouette. Computed Tomography (CT) chest showed 2.2 x 2.5 cm aneurysmal area seen left of the RV-PA conduit, communicating with the previous pulmonary artery stump. He was taken to the OR and found to have ventricular pseudoaneurysm related to contained RV rupture from the infected intraventricular baffle. All the infected tissue including the RV to PA conduit and intraventricular baffle was removed and converted to single ventricle physiology with atrial septostomy and PA banding. He returned to the PICU on ECMO due to inability to come off cardiopulmonary bypass and significant bleeding. He was decannulated in 4 days and remained stable with Spo2 in 75-85%. He recently was discharged home pending a long-term surgical plan.
Conclusion: Ventricular pseudoaneurysms are potentially fatal. Similar to our index patient; younger age, smaller size, use of pulmonary homograft conduit, and IE are known risk factors. A high degree of suspicion and appropriate imaging is necessary to diagnose, and timely surgical repair can prevent fatal ventricular rupture.