a case of LV pseudoaneurysm in a pediatric patient: closed using a transcatheter technique

1. A rare case of Pediatric LV pseudoaneurysm (Post
Traumatic) and successful transcatheter closure
Dr Manish N Chokhandre
Consultant Paediatric Cardiologist
Swasthyam Superspeciality Hospital,
Nagpur, India.

2. DISCLOSURE - None
I, Manish Chokhandre DO NOT have a financial interest/arrangement or
affiliation with one or more organizations that could be perceived as a real or
apparent conflict of interest in the context of the subject of this presentation.

3. Case summary
• 7 year old girl
• Admitted with lower limb cellulitis
• Abscess over left ankle
• Child developed multiple abscess over right thigh, scapular, left popliteal
region sequentially
• Raised count, low Hb
3

4. Diagnosis
• Lower limb cellulitis with sepsis

5. Case summary
• Incision and drainage
• Treated with broad spectrum antibiotics (M,L,Clind, Flucon)
• Developed b/l pleural effusion and puffiness of face (Hypoalbuminemia/sev
anemia)
• Received PRBCs and albumin

6. Case summary
• b/l pleurocentesis was done (chest tube drain on right and tapping on left
side)
• Post Pleural tapping developed pericardial effusion –managed
conservatively
• Gradually increased to severe global effusion

7. ECHO-Global pericardial effusion

8. ECHO-Global Pericardial Effusion

9. • Managed conservatively and subsequently discharged

10. Subsequent course
• 2 weeks post discharge
- Chest pain
- Palpitation
- Dyspnoea
- No FEVER

11. Examination
• Tachycardia
• Diffuse and prominent apex impulse
• No murmur
• Normal S2
• Healed scars over leg, thigh and scapular region

12. ECHO

13. ECHO : 2 weeks post discharge

14. 2 weeks
LV
pseudoaneurysm
6mm

15. SAX view
LV
LVP
4 mm

16. Diagnosis
• Post traumatic left ventricular pseudoaneurysm with heart
failure
• Adv: Surgery

17. ECHO- 4 weeks post discharge
Pseudoaneurysm
LV
9 mm

18. Impression
• Giant Pseudoaneurysm of Left Ventricle
• Gradually increasing dimensions of pseudoaneurysm and its
communication (9 mm x 11 mm) with LV

19. Treatment options
• Surgical
-High risk
-high mortality
-morbidity associated with sternotomy and bypass
• Transcatheter/Percutaneous closure

20. Challenges for transcatheter closure
• Large defect
• 18 Kg
• Proximity to mitral valve
• Entrapment of mitral valve chordae and development of mitral
regurgitation.
• Risk of rupture during catheter manipulation
20

21. Transcatheter closure

22. LVP angio

23. Device deployment

24. Device deployment

25. Final angio

27. ECHO post procedure

28. LV Pseudoaneurysm in Children
• Extremely rare but serious clinicopathologic entity
• outpouching is formed when cardiac rupture is contained by adherent
pericardium or scar tissue, with no myocardial tissue
• clinical presentation - nonspecific, including congestive heart failure, chest
pain, dyspnea or arrhythmia leading to a delay in the diagnosis

29. Causes
• MI (55%), surgery (33%), and trauma (7%) were the top 3 associations
• Left ventricular pseudoaneurysms in children can occur following infection,
trauma, ischemia, or cardiac surgery
• Untreated-rupture risk in LVPs increases to 48%.

30. Treatment
• Surgical repair
• Transcatheter closure
• Surgical repair of posttraumatic LVP has a reported mortality of > 7%.

39. What is unique about this case?
• Post traumatic – rapid progression
• 1st pediatric case where such a large aneurysm closed using percutaneous
technique
• 1st pediatric case where Konar MFO used as occluder device (Lifetech
Konar 14mm x 16 mm)

40. Conclusion
•Cardiac rupture (LVP) is life threatening complication of pleural tapping.
•Post pleural tapping pericardial effusion- pericardial tapping is must
•Percutaneous closure can be performed safely and effectively, and may be considered
as a treatment option even in young children
40

41. • Thank You