Repair of Iatrogenic RVOT Pseudoaneurysm
A follow-up echocardiogram two weeks later showed a multilobed right
ventricular pseudoaneurysm, measuring at its mouth 11 millimeters.
To-fro flow was seen without any thrombus formation and a mild to
moderate pericardial effusion. This was confirmed with CT.
patient was taken to the operating room weighing 2.9 kilograms. After
median sternotomy, the pericardium was incised except the part
overlaying the pseudoaneurysm, which was left untouched until
satisfactory cannulation was achieved.
Bypass was initiated with aortic and inferior vena cava cannulation. The pseudoaneurysm was closely inspected, paying significant attention to its proximity to the left anterior descending coronary artery (LAD). The superior vena cava was cannulated, the aorta was clamped, antegrade cardioplegia was started, and the patient was cooled to a rectal temperature of 32°C. The right atrium was incised and the left heart vented through the patent foramen ovale (PFO). The authors chose to do the repair under cardiac arrest given the close proximity to the LAD. The pseudoaneurysm was inspected again and excised to its fibrous rim. The pulmonary valve was inspected and a patch of Cardiocel neopericardium was prepared. A running suture with 6-0 polypropylene was started on the most lateral edge closest to the LAD. The fibrous rim was considered strong enough to hold the bites from the suture, which was continued superiorly. Care was taken not to damage the pulmonary valve or LAD. The patch was trimmed to its appropriate size.
suture line was tied and the final result inspected. A series of 6-0
polypropylene horizontal mattress sutures were placed to reinforce and
The heart was de-aired and the
aortic clamp removed. The PFO was closed primarily followed by the
atriotomy closure and intracardiac line placement. The patch area was
covered with hemostatic glue and the chest closed.