A life-threatening infective pseudoaneurysm of the left ventricle in a toddler

Repair of contained ventricular rupture with infected intrapericardial thrombus

Contained left ventricular rupture, or pseudoaneurysm, is a rare entity resulting from adhesions confining the defect to a localized portion of the pericardial space. Concomitant infection is even more infrequent. We present the first-known case of a patient with an infected intrapericardial thrombus from a left ventricular rupture.

Complicated community-acquired methicillin-resistant Staphylococcus aureus pancarditis with cardiac pseudoaneurysm in a healthy child: A case report

INTRODUCTION

Infective endocarditis is more prevalent among children with congenital heart diseases as compared to healthy children. Community-acquired methicillin-resistant Staphylococcus aureus is a causative pathogen of infective endocarditis, and it rarely causes pancarditis in healthy children. The clinical decision for surgical intervention of left-sided heart vegetation is challenging despite the availability of management guidelines.

PRESENTATION OF CASE

We report a case of a previously healthy 12-year-old girl who presented with aggressive endocarditis secondary to community-acquired methicillin-resistant Staphylococcus aureus infection, with left-sided vegetation, mitral valve regurgitation, pancarditis, brain abscess, and stroke. She underwent an emergency vegetectomy and mitral valve repair. Three weeks after the first surgery, she developed left ventricular pseudoaneurysm that required life-saving surgical intervention. The child gradually recovered and was discharged home with acceptable cardiac function and mild neurological deficit.

DISCUSSION

Pancarditis, especially with an aggressive progression resulting in intracardiac pseudoaneurysm, is rarely reported in healthy children. The definition of the optimal timing of surgical intervention in pediatric infective endocarditis management is lacking and the clinical decision-making process remains challenging. The development of left ventricular pseudoaneurysm is serious and also needs an immediate intervention, given the high risk of its rupture and subsequent devastating outcomes.

CONCLUSION

Community-acquired methicillin-resistant Staphylococcus aureus is an etiology for aggressive infective pancarditis in a healthy child, leading to an intracardiac pseudoaneurysm. Emergency surgical interventions should be considered in children with left-sided vegetation to prevent devastating consequences.

Infectious pseudo-aneurysm of the left ventricle: a case report and a review of the literature

BACKGROUND

In the workup of a pediatric patient with pericarditis we found evidence of a pseudo-aneurysm of the left ventricle, which is a rare complication of purulent pericarditis.

CASE PRESENTATION

We present a case of a six-year-old girl who was diagnosed with pericarditis and a fistula between the pericardial and the intra-luminal space of the left ventricle of the heart. She was successfully treated with antibiotics and cardio-thoracic surgery. We found 23 published cases (21 with follow-up) of infectious pseudo-aneurysm of the heart, of which 19 underwent surgery, 5 had fatal outcome, and 2 who refused surgery survived. The majority of cases were associated with Staphylococcus aureus. The exact mechanisms of this rare complication remain unknown.

CONCLUSIONS

A pseudo-aneurysm of the left ventricle is a rare and not well understood complication of a purulent pericarditis most commonly caused by Staphylococcus aureus infection. Because of risk of rupture, surgical intervention is advised.

Left Ventricular Pseudoaneurysms in Children-A Case Series

Left ventricular pseudoaneurysms are very rare in children. In children, left ventricular pseudoaneurysms can occur following infection, trauma, ischemia, or cardiac surgery. The authors report a series of three cases treated at our hospital with two of the cases having a history of extrapulmonary tuberculosis and one patient with a history of varicella zoster infection.