Mycotic Pseudoaneurysm Complicating Stent Placement for Native Aortic Coarctation in a Child (original) (raw)
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Mycotic aneurysm complicating a covered stent implanted for coarctation of the aorta in a child
World journal for pediatric & congenital heart surgery, 2012
A mycotic aneurysm associated with a covered stent in the thoracic aorta of a 12-year-old child was successfully managed by excision and replacement with aortic homograft. On follow-up, there was unobstructed flow through the homograft. This case highlights the need for high index of suspicion for mycotic aneurysm and prompt surgical intervention in children with coarctation of aorta who present with features of infective endocarditis.
Mycotic Pseudoaneurysm of the Aorta in Children
Pediatric Cardiology, 2000
Mycotic pseudoaneurysm of the aorta is a rare disease in childhood. We report on two cases which were diagnosed in an unselected general pediatric population within an 8-month period. The first case was a 16-monthold toddler with a normal cardiac history who presented with purulent pericarditis due to group A steptococcus and subsequent pseudoaneurysm formation of the ascending aorta while convalescing from varicella infection. The second case was a 14-year-old girl with a previously undiagnosed coarctation of the aorta who developed a Staphylococcus aureus aortitis in the dilatated poststenotic segment with pseudoaneurysm formation and infiltration into the adjacent lung tissue. In both cases parenteral antibiotic therapy was administered over 10 and 4 days, respectively, followed by emergency surgery consisting of aneurysmectomy, coarctectomy (case 2), and in situ homograft implantation. Recovery was uneventful. In both cases early institution of a femorofemoral cardiopulmonary bypass prevented a fatal outcome despite intraoperative rupture of the pseudoaneurysm.
Repair of mycotic aortic pseudoaneurysm with a stent graft using transesophageal echocardiography
Journal of Vascular Surgery, 2004
A 54-year-old man who underwent uneventful orthotopic heart transplantion 1 year previously had low-grade fever and dyspnea. Imaging studies revealed an ascending aortic pseudoaneurysm (AAP), which was repaired with a 5-mm polyester patch, with circulatory arrest and cardiopulmonary bypass. Intraoperative cultures of the AAP grew methicillin-resistant Staphylococcus aureus, and the pseudoaneurysm recurred after 6 weeks despite intravenously administered antibiotic therapy. A 28.5-mm ؋ 3.3-cm Gore Excluder aortic cuff was deployed in the ascending aorta through a left axillary artery cutdown with use of combined transesophageal echocardiography and fluoroscopy. In addition, controlled hypotension and asystole were established with administration of adenosine to facilitate precise device deployment. Postoperative imaging with transesophageal echocardiography and magnetic resonance angiography revealed complete resolution of the AAP, and the patient had done well at 7-month follow-up. Treatment of a mycotic aortic pseudoaneurysm with an endoprosthesis in a patient without other treatment alternatives can be performed safely, with acceptable short-term results.
Journal of Vascular Surgery, 2015
Although not currently available in the United States, multilayer stents have been used successfully to treat a variety of aneurysms. These stents promote laminar flow and depressurize the aneurysmal portion of the vessel, while preserving side branch vessel flow. A conceivable benefit of the multilayer stent is in the treatment of infected pseudoaneurysms, given the absence of a fabric covering, a potential nidus for colonization. Here we present the case of a 64-year-old woman with symptomatic, enlarging infrarenal mycotic pseudoaneurysms who was successfully treated with an in vivo multilayer stent created by the layering of three concentric bare-metal Wallstents (Boston Scientific, Natick, Mass).
Stent-Graft Repair of a Mycotic Left Subclavian Artery Pseudoaneurysm
Journal of Endovascular Therapy, 2003
To report successful stent-graft treatment of a mycotic pseudoaneurysm of the left subclavian artery in an immunosuppressed patient. Case Report: A 17-year-old immunosuppressed woman undergoing treatment for recurrent leukemia developed persistent fever and 2 episodes of hemoptysis. A contrast-enhanced computed tomographic (CT) scan demonstrated a saccular aneurysm of the left subclavian artery, which was considered to be a mycotic aneurysm caused by erosive fungal infection from the lung. The pseudoaneurysm was treated with a homemade stent-graft consisting of a nitinol stent and a polyester fabric. A type II endoleak present at the end of the procedure appeared to have sealed spontaneously on the CT scan at 3 days. No neurological deficit or ischemic symptoms of the left arm were noted during the follow-up, which lasted until the patient died 11 months later after rejecting a second bone marrow transplant. Conclusions: Endovascular repair may be an alternative to open surgery for the management of mycotic aneurysms of the subclavian artery.
Giant mycotic pseudoaneurysm of the aorta protruding over the sternal notch in a child
Interactive CardioVascular and Thoracic Surgery, 2016
Aortic mycotic pseudoaneurysms are rare pathologies in children, which are mostly caused by an infection or trauma. Surgical and perioperative antibiotic therapies are mandatory in the treatment. Surgical timing and operational strategy are also critical factors. Herein, we report the successful repair of a giant mycotic pseudoaneurysm of the ascending aorta following a previous cardiac surgery in a 7-year old girl.
Multiple Mycotic Aneurysms and Transverse Myelopathy Complicating Repair of Aortic Coarctation
The Annals of Thoracic Surgery, 1982
The case of an 18-year-old man with coarctation of the aorta discovered on routine physical examination and subsequently surgically repaired is reported. Four months postoperatively, aneurysms developed at the repair site and thrombosis of both femoral arteries was noted. Following an attempt to repair the aneurysm and remove the thrombi, the patient became paraplegic; Aspergillus furnigatus was found infecting the aorta and femoral vessels. After additional operations and a course of amphotericin B to control the fungal infection, the patient died of intrathoracic bleeding originating from infected, aneurysmally dilated intercostal vessels in the area of the original coarctation repair.
Endovascular Repair of an Acute, Mycotic, Ascending Aortic Pseudoaneurysm
European Journal of Vascular and Endovascular Surgery, 2011
This report describes endovascular stenting of an acute mycotic ascending aortic aneurysm. An eighty-three year old lady presented nine weeks after aortic valve surgery and subsequent thyroidectomy with sternal pain secondary to a mycotic ascending aortic pseudoaneurysm. The pseudoaneurysm was visible through the unhealed sternum. Open repair was considered too high a mortality risk. Endovascular stenting was performed using two covered infrarenal proximal extension devices (GORE Excluder Aortic Extender Ò , W. L. Gore & Associates, Flagstaff, Arizona, USA) deployed from a right axillary approach utilising overdrive cardiac pacing. Post procedure imaging revealed shrinkage of the pseudoaneurysm sac.