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Mycotic pseudoaneurysm of the aorta in children
1Department of Pediatrics, Philipps University of Marburg, Deutschhausstrasse 12, 35033 Marburg, Germany.
Insights
Childhood mycotic aortic pseudoaneurysms are rare. This report details two pediatric cases, highlighting successful surgical and antibiotic interventions for ascending aorta and coarctation-related pseudoaneurysms, preventing fatal outcomes.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Vascular Surgery
Background:
- Mycotic pseudoaneurysm of the aorta is an uncommon pediatric condition.
- Early diagnosis and intervention are crucial for managing aortic pseudoaneysms in children.
Observation:
- Two pediatric cases of mycotic aortic pseudoaneurysm were identified within an 8-month period.
- Case 1: A 16-month-old with ascending aorta pseudoaneurysm secondary to group A streptococcus pericarditis and varicella.
- Case 2: A 14-year-old with Staphylococcus aureus aortitis and pseudoaneurysm in a post-coarctation segment.
Findings:
- Both patients received parenteral antibiotic therapy followed by emergency surgery, including aneurysmectomy and homograft implantation.
- Femorofemoral cardiopulmonary bypass was critical in managing intraoperative pseudoaneurysm rupture, ensuring survival.
- Surgical interventions included coarctectomy in the second case.
Implications:
- This case series underscores the importance of considering mycotic aortic pseudoaneurysms in pediatric patients with relevant infections.
- Prompt diagnosis, aggressive antibiotic treatment, and timely surgical management, including cardiopulmonary bypass, are vital for favorable outcomes.
- These findings emphasize the feasibility of in situ homograft implantation for complex pediatric aortic pseudoaneurysms.
Abstract:
Mycotic pseudoaneurysm of the aorta is a rare disease in childhood. We report on two cases which were diagnosed in an unselected general pediatric population within an 8-month period. The first case was a 16-month-old toddler with a normal cardiac history who presented with purulent pericarditis due to group A streptococcus and subsequent pseudoaneurysm formation of the ascending aorta while convalescing from varicella infection. The second case was a 14-year-old girl with a previously undiagnosed coarctation of the aorta who developed a Staphylococcus aureus aortitis in the dilated poststenotic segment with pseudoaneurysm formation and infiltration into the adjacent lung tissue. In both cases parenteral antibiotic therapy was administered over 10 and 4 days, respectively, followed by emergency surgery consisting of aneurysmectomy, coarctectomy (case 2), and in situ homograft implantation. Recovery was uneventful. In both cases early institution of a femorofemoral cardiopulmonary bypass prevented a fatal outcome despite intraoperative rupture of the pseudoaneurysm.