Giant pseudoaneurysm of the right ventricular outflow tract after repair of truncus arteriosus: evaluation by MR imaging and surgical approach

Abstract

One year after surgical repair of the truncus arteriosus, a 1-year 8-month-old boy was found to have a pseudoaneurysm of the right ventricular outflow tract (RVOT). Cine-magnetic resonance imaging (MRI) showed a narrow communication between the RVOT and aneurysm. MRI was useful to evaluate the anatomical and spatial relations between the pseudoaneurysm and the surrounding structures, therefore an appropriate approach was chosen. Thus, a median sternotomy approach was carried out and ordinary central cannulation was feasible to establish a cardiopulmonary bypass. The defect was successfully repaired with reconstruction using a monocuspid outflow patch. MRI provided useful information for deciding the surgical approach.

Cardiac magnetic resonance of the common arterial trunk and transposition of the great arteries

“…Even pseudoaneurysms of the right ventricular outflow tract after truncal repair has been noted by cardiac magnetic resonance. 17 Delayed enhancement imaging, also called ''viability'' imaging, can be utilised to identify patch material of the ventricular septal defect or the right ventricle to pulmonary artery conduit; 18 this may explain paradoxical or akinetic regions of the right ventricle. The finding of patch material demonstrating delayed enhancement was attributed to fibrous tissue that may be relevant in the development of conduit stenosis.…”

Dysfunctional pulmonary artery conduit and co-existing large pseudoaneurysm: well-suited for a percutaneous approach with the Melody valve?

“…In most patients, the pseudoaneurysm can be resected under cardiopulmonary bypass on a beating heart. Surgery can be carried out safely with low mortality and morbidity, and is considered the mainstay treatment (Yeo et al 1998 ; Murashita et al 2002 ). On the other hand, as the pseudoaneurysm originates from the right ventricular outflow tract and lies just behind the sternum, there is the risk of bisecting during sternotomy.…”

Pseudoaneurysm of Surgically Reconstructed Right Ventricular Outflow Tract Complicated by Superior Vena Cava Syndrome

“…CT was also useful in evaluating the safety of performing another sternotomy in light of the possible need for femoral or neck vessel cannulation before another sternotomy. Preoperative magnetic resonance imaging may also provide information helpful in choosing the best surgical approach [ 5 ]. However, magnetic resonance imaging is more time-consuming than CT, and is difficult to perform in haemodynamically unstable patients.…”