Repair of ascending aortic aneurysm after heart-lung transplantation - A paediatric case report

Ascending aortic aneurysm is a rare complication occurring after combined heart-lung transplants. Most post-transplant aortic pathologies are infective in origin and typically present as mycotic pseudoaneurysms or with features of aneurysmal rupture leading to hemodynamic instability. We report the case of a 13-year-old girl who underwent heart-lung transplantation 8 months back, presenting with a large unruptured ascending aortic aneurysm with stable hemodynamics. Surgical repair was performed using a collagen-coated polyester tube graft under cardiopulmonary bypass with peripheral femoral cannulation. The post-operative course was uneventful, and the patient was discharged in stable condition. Microbiological examination of the resected specimen showed no infective etiology, and histopathology analysis showed normal findings. The site of aortic anastomosis is a potential source of aneurysm. Discrepancy in tissue quality between the donor and recipient aorta can be responsible for compliance mismatch that causes a difference in wall tension, causing critical stress at the anastomosis. This case highlights the need for vigilant surveillance of the ascending aorta in transplant recipients irrespective of donor aorta, to allow timely detection and management of aneurysmal complications, and the need for screening of donor tissues for connective tissue disorder to monitor the recipient post-operatively.