An Infectious Pseudoaneurysm Caused by Ventricular Septal Defect Occluder in Patent Ductus Arteriosus Closure in a Two-Year-Old Child

Abstract

SummaryWe present a case of an infectious pseudoaneurysm after patent ductus arteriosus (PDA) closure with a ventricular septal defect (VSD) occluder in a two-year-old child. The aneurysm grew rapidly but was successfully removed in time and the patient survived. To our knowledge, this is the first report of an infectious pseudoaneurysm caused by VSD occluder in PDA closure.(Int Heart J 2017; 58: 1017-1019) Key words: Aneurysmal dilatation, Infectious endocarditis, Transcatheter A neurysmal dilatation of ductus arteriosus has been considered a rare but potentially fatal abnormality. It can be either congenital or acquired as a complication of surgical ligation of patent ductus arteriosus (PDA) or after a ductal infection. And the congenital ones were much commoner than the acquired ones. In the early days, the surgical method for PDA was excision, which was replaced by occluder nowadays. There were case reports on ductus arteriosus aneurysm in PDA excision.1,2) However, to our knowledge, this is the first report of pseudoaneurysm caused by PDA occluder. Case ReportA two-year-old girl (weighing 10.5 kg) presented with a week history of cough. A physical examination revealed a continuous murmur at the second left intercostal space. Transthoracic echocardiogram revealed a PDA (Figure 1).The patient underwent right heart catheterization. A 5 French (Fr) sheath was inserted into the right femoral vein, followed by a 5-Fr MPA1 catheter, and right-sided pressures were recorded. The catheter was removed, flushed, and then inserted into the right femoral artery. The left-sided pressures were then recorded.The patient was found to have a funnel-shaped PDA (5 mm pulmonary end diameter, 13 mm aortic end diameter and 8 mm length) with preprocedural shunt and Qp:Qs of 4.1:1 (Figure 2). Right heart catheterization demonstrated a pulmonary arterial pressure of 90 mmHg/50 mmHg (mean 63 mmHg) with a mean pulmonary capillary wedge pressure of 7 mmHg. The pulmonary vessel resistance was 459 dynes sec cm-5.A 14 mm muscular ventricular septal defect (mVSD) occluder (Starway Medical Technology, China) was advanced to the site of the PDA through a 9 Fr delivery system. Its subsequent deployment closed the PDA. Postprocedural pulmonary arterial pressure was recorded as 50 mmHg/30 mmHg (mean 37 mmHg). Postoperative transthoracic echocardiogram (TTE) found no residual shunt. 0.5 g Cefazolin was given prophylactically 40 minutes before the procedure and 11.5 hours after the procedure. The postoperative examinations were normal and the patient was discharged. However, the patient came down with a fever of 40 15 days after the procedure and was transferred from a local hospital to ours. The high fever has been lasting and no response for medicines with Vancomycin and Meropenem for 2 weeks at local hospital. TTE showed that the occluder seemed to drop into the main pulmonary artery. The cardiac computed tomographic angiography revealed an aneurysmal dilatation of the ductus arteriosus with a maximum diameter of 30 mm (Figure 3, 28*30 mm). The...

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