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

Abstract

Pseudoaneurysm formation is a rare but potentially life-threatening complication after surgical repair of congenital heart disease. We present a boy with truncus arteriosus communis 14 years after homograft placement in pulmonary position. On follow-up, he presented progressive chronic homograft degeneration. Moreover, a large pseudoaneurysm in the right ventricular outflow tract was surprisingly depicted. We opted for a two-stage interventional approach.

Keywords: Homograft degeneration; Percutaneous pulmonary valve implantation; Pseudoaneurysm; Right ventricular outflow tract conduit; Two-stage interventional approach.

Fig. 1

Guided by a wire-supported 8 French long sheath, the rounded-shaped pseudoaneurysm was entered via a 4 French endhole-catheter with a floppy 0.014 inch coronary wire (a). Its lumen and neck measured around 20 and 5 mm. Control angiography before Amplatzer™ Duct Occluder II 6–4 mm release, which was delivered via the corresponding 5 French TorqVue™ system (b). Implantation of the first pre-stent (c)

Fig. 2

Re-catheterization revealing excluded pseudoaneurysm and stable pre-stent position (a). Well prepared landing-zone after implantation of two more pre-stents (b). Final result after percutaneous pulmonary valve implantation (c)