日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Infectious aneurysms are rare complications of the modified Blalock–Taussig (mBT) shunt procedure. These aneurysms may have fatal outcomes and require prompt treatment; however, standardized treatment is lacking. This is a report of a successful case in which an infectious aneurysm that developed following mBT shunt placement was treated safely with a hybrid procedure involving catheterization. The patient was a 5-month-old boy who underwent left mBT shunt placement for tetralogy of Fallot. He subsequently presented with decreased oxygenation, and contrast-enhanced computed tomography revealed an aneurysm at the shunt insertion site. Blood culture was positive for Staphylococcus capitis, suggesting that the infectious aneurysm was caused by the bacterium. Antibiotic treatment alone was insufficient; and catheter removal of the infectious lesion was considered necessary. Due to the risk of rupture and aneurysmal bleeding during sternotomy, a blood vessel entering the aneurysm was obstructed using an indwelling balloon catheter. The aneurysm was removed after blood flow was completely blocked, and a right ventricular outflow tract repair was performed concomitantly to secure new pulmonary blood flow. The patient was discharged from the hospital 56 days postoperatively. This case demonstrates a promising adjunctive procedure for the treatment of infectious aneurysms.