Anastomotic pseudoaneurysm of the ventricle after homograft placement in children.

Abstract

A pseudoaneurysm of the right ventricle was diagnosed postoperatively in 8 patients between 1986 and 1992. One pseudoaneurysm formed after placement of a Carpentier-Edwards conduit and the other seven arose after placement of a homograft between the right ventricle and the pulmonary artery. Both aortic (n = 3) and pulmonary (n = 4) homografts had been used. In 6 patients, the homografts had been augmented proximally with Dacron, Gore-Tex, or pericardium. Pseudoaneurysms originated between the augmentation patch and the homograft in 4 patients, between the homograft or conduit and the myocardium in 3 patients (1 patient with and 2 without an augmentation patch), and between the patch and the myocardium in 1 patient. The prior operations performed were placement of a palliative conduit for tetralogy of Fallot with pulmonary atresia (n = 5), repair of truncus arteriosus (n = 2), and repair of absent pulmonary valve syndrome (n = 1). Pseudoaneurysms were discovered from 5 weeks to 4 years after the operation. Symptoms were present in 3 patients; in the others, diagnosis was made during follow-up on the basis of routine imaging studies. Symptoms, when present, were due to compression of surrounding mediastinal structures. Pseudoaneurysms ranged in diameter from 1.0 to 5.0 cm. Echocardiography and color-flow mapping reliably identified the pseudoaneurysm in the 6 patients in whom it was performed. Characteristic features included a well-defined, narrow aneurysm neck leading to an extracardiac echo-free space. Color-flow mapping demonstrated to-and-fro flow through the neck of the aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)