A Surgical Case of a Pseudoaneurysm of the RV-PA Conduit Infection due to Mediastinitis after Palliative Rastelli Surgery

Abstract

We experienced successful surgical treatment of a pseudoaneurysm of a RV-PA conduit in a 15-month-old female patient whose original diagnosis was pulmonary atresia with ventricular septal defect. Her first operation was a central shunt at the age of 25 days. She underwent a palliative Rastelli procedure (valved conduit of 10 mm e-PTFE graft) when she was 10 months old, but bacterial mediastinitis occurred (Pseudomonas aeruginosa) on the 8th postoperative day, and drainage and negative pressure wound therapy were started combined with administration of antibiotics. It took one month to close the wound when the bacterial culture from the wound became negative. Although she was discharged from hospital on the 49th postoperative day, she was re-hospitalized after 10 days because of high fever. Echocardiography and CT showed no sign of vegetation or breakdown of the conduit and conservative therapy with antibiotics were continued. Two months later, enhanced CT demonstrated a large pseudoaneurysm which originated from the RV-conduit anastomotic site and urgent surgery was performed. Cardiopulmonary bypass was established with the right common carotid artery and internal jugular vein and the infected conduit was replaced with larger-sized one under electrically-induced ventricular fibrillation. Delayed sternal closure with omental filling was performed after 6 days. Fifteen months have passed since conduit replacement and she is now in good condition without recurrence of infection.