Catheter Closure of Pseudoaneurysm of the Main Pulmonary Artery
These images demonstrate the use of an Amplatzer duct occluder (AGA Medical) for treatment of a large pseudoaneurysm of the main pulmonary artery after bilateral bidirectional Glenn operation. The patient is a 3-year-old girl who initially presented at 3 months of age with a diagnosis of single-ventricle severe pulmonary hypertension resulting from increased pulmonary blood flow and coarctation of aorta with normally related great arteries. She underwent pulmonary artery banding with coarctation repair (at 3 months), followed by a bilateral bidirectional Glenn shunt with interruption of the main pulmonary artery at the band site at the age of 2 years. She presented with recurrent hemoptysis that started 2 weeks before the current admission. Clinical evaluation at admission showed evidence of reduced air entry in the left hemithorax. Chest x-ray revealed a dense opacity in the left upper lobe with hyperinflation of the right hemithorax (Figure 1). Contrast-enhanced computed tomography of the chest revealed a 41×35 mm pseudoaneurysm arising from the main pulmonary artery (MPA) partly filled with thrombus (Figure 2). The angiogram of the MPA revealed a large tri-lobed pseudoaneurysm arising from its stump (Figure 3A). The neck of the pseudoaneurysm was occluded using a 12×10 mm Amplatzer duct occluder with the “aortic retention disc” deployed inside the wider portion of the neck and the rest of the device in the MPA stump (Figure 3B). The child required mechanical ventilation for 4 days after the procedure because of impaired gas exchange. The chest x-ray cleared over the next 5 days (Figure 4) and the patient was discharged.