Abstract
Introduction. The development of а right ventricular outflow tract (RVOT) false aneurysm after complete repair of
complex congenital heart defects (CHD) is a rare complication with the incidence of about 2%. However, its progression
can lead to rupture of the external aneurysm wall and may cause fatal bleeding.
Objective. The goal of the study is to identify the causes of false aneurysm of the RVOT after the complete repair of
complex CHD and to determine the indications and tactics for its surgical treatment.
Material and methods. During 2004–2019 in the Department of Surgical Treatment of Older Children with CHD,
the false aneurysm of RVOT repair was performed in 6 patients undergone complex CHD complete correction earlier.
The age of patients at the time of radical correction of CHD ranged from 3 to 14 years (median – 8 years), the
interval between radical correction and repeated intervention for a false right ventricular aneurysm ranged from 1 to
11 years (median – 3.5 years). In all cases, these were re-do operations after a previous complete CHD correction
with the use of either a transannular patch (n=5) or a valve-containing conduit (n=1) for RVOT plasty. In 3 cases,
the lesion was represented by tetrology of Fallot, pulmonary atresia with ventricular septal defect (n=1), combined
pulmonary stenosis (n=1) and Bland–White–Garland syndrome (n=1). In 4 cases the operation was performed on
a beating heart, in 2 cases, the cardiopulmonary bypass and cardioplegia were used.
Results. The main indication for re-operation was a large false aneurysm of RVOT associated with a residual ventricular
septal defect in one case and pulmonary artery stenosis in majority of cases. We revealed infective endocarditis,
acute chest trauma as possible causes of false aneurysm in our study. In other cases, there was high RV pressure,
progressing after a radical correction and exceeding more than 50% of the systemic at the time of the second intervention
in 5 out of 6 patients. All patients managed to eliminate the pathological communication between RVOT and
the cavity of the false aneurysm and perform a repeated reconstruction of RVOT. There was one hospital death due
to the bleeding caused by the intraoperative lung trauma.
Conclusion. The diagnosis of a false aneurysm of the RVOT after a radical correction of complex CHD should be
based on the study of clinical and anamnestic data of patients, and the crucial method is radiation diagnosis.
Surgical treatment of this pathology, although it is associated with a high risk of intraoperative bleeding, is necessary
and effective.
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About the authors
- Vladimir P. Podzolkov, Dr. Med. Sc., Professor, Academician of Russian Academy of Sciences, Head of Department, orcid.org/0000-0002-2863-2072
-
Mikhail R. Chiaureli, Dr. Med. Sc., Professor, Chief Researcher, orcid.org/0000-0002-6456-9269
-
Dmitriy V. Kovalev, Dr. Med. Sc., Leading Researcher, orcid.org/0000-0002-4586-9258
-
Viktor B. Samsonov, Dr. Med. Sc., Leading Researcher, orcid.org/0000-0002-6477-7914
-
Timur Yu. Danilov, Dr. Med. Sc., Leading Researcher, orcid.org/0000-0002-9409-3230
-
Vladimir N. Cheban, Dr. Med. Sc., Leading Researcher, orcid.org/0000-0002-4608-7661
-
Ol'ga I. Medvedeva, Dr. Med. Sc., Deputy Head of Department, orcid.org/0000-0002-5381-2921
-
Anna A. Nezhlukto, Cand. Med. Sc., Researcher, orcid.org/0000-0001-8769-4487
