Anatomical repair of a congenital aneurysm of the distal abdominal aorta in a newborn

Congenital Abdominal Aortic Aneurysm: A Case Report and Literature Review

Congenital abdominal aortic aneurysm is a rare disease with unknown etiology, and the common symptoms are abdominal pulsatile mass and pain caused by aneurysm rupture. The disease has a high mortality rate and fewer reports of surgical treatment. Here, we present a case of an idiopathic congenital abdominal aortic aneurysm. A 4-year-old boy had an abdominal pulsatile mass, and computed tomography angiography revealed an isolated infrarenal abdominal aortic aneurysm. To prevent rupture of the aneurysm, we repaired the aneurysm with artificial graft transplantation. No genetic mutation of the known congenital aneurysmal diseases was found in the whole-exome sequencing of the patient and his parents. There was no graft obstruction, and the patient grew well 40 months after surgery. Open surgery is the best treatment for idiopathic congenital abdominal aortic aneurysms. Surgical details such as timing and graft selection need to be further explored.

Neonatal Microsurgical Repair of a Congenital Abdominal Aortic Aneurysm with a Cadaveric Graft

Congenital abdominal aortic aneurysms (AAA) are an extremely rare entity. We present the case of a female fetus diagnosed with an AAA on routine prenatal ultrasound. A postnatal computed tomography angiogram revealed an infrarenal AAA with a narrow proximal neck. Surgery was performed on day of life 14 using a cadaveric femoral artery graft. The proximal anastomosis was performed under the microscope given the severity of the aortic stenosis and the proximity of the renal arteries. The patient's postoperative course was uneventful and she is developing normally 1 year after surgery. The graft remains permeable, albeit with evidence of proximal and distal stenosis and graft calcification on imaging.

Ruptured abdominal aortic aneurysm in an 11-year-old with multiple peripheral artery aneurysms

Pediatric abdominal aortic aneurysms (AAAs) are rarely encountered in clinical practice. The combination of a pediatric AAA in a patient with multiple peripheral artery aneurysms is even more rare. We report the management of an 11-year-old boy who presented with a ruptured AAA who also had multiple peripheral arterial aneurysms. Infectious, genetic, and inflammatory workup was negative, classifying this aneurysm as congenital.

Congenital Abdominal Aortic Aneurysm in a Four Year Old Girl

Introduction

Abdominal aortic aneurysm (AAA) in neonates, infants, and children is uncommon, usually occurring as a result of infections, connective tissue disorders, vasculitis, or iatrogenic trauma. A case of idiopathic congenital AAA, an extremely rare disease of unknown origin, is described.

Report

In March 2018, a 40 mm hypoechoic mass adjacent to the left kidney was detected incidentally by abdominal ultrasound for investigation of hypercalciuria in a four year old girl. Contrast enhanced computed tomography (CT) revealed an infrarenal fusiform AAA measuring 39 mm in maximum diameter, a 15 mm left renal artery aneurysm, a 14 mm right hypogastric artery aneurysm, and a 12 mm left hypogastric artery aneurysm. Cerebral magnetic resonance imaging revealed multiple intracranial aneurysms between 8 and 15 mm in diameter. Considering the size of the AAA and risk of rupture, surgical repair was planned. In May 2018, the congenital AAA was successfully repaired with a 10 mm Dacron aorto-aortic tube graft. Increases in the size of the left renal artery aneurysm and a left middle meningeal artery aneurysm were detected 12 and 14 months post-operatively, respectively. Coil embolisations were performed. An intracranial dural arteriovenous fistula (AVF) was discovered incidentally by cerebral angiography for treatment of the left middle meningeal artery aneurysm. Transarterial embolisation for AVF was also performed. At the 21 month post-operative follow up, the patient is doing well, and the untreated aneurysms have not grown.

Conclusion

Long term outcomes after surgical repair for congenital AAA are unclear. Moreover, growth of residual aneurysms was detected post-operatively, so follow up with frequent multimodality imaging for multiple aneurysms is necessary.

Surgical Repair of Congenital Abdominal Aortic Aneurysm in a 1-year-old Child with Literature Review

Reported here is a case of 1-year-old male child who presented with huge abdominal mass, which on radiological investigation was diagnosed as retroperitoneal pseudoaneurysm of the aorta. On exploration, it was found to be a true aneurysm of infrarenal abdominal aorta with inflow agenesis. Aneurysm was excised, and aorta was reconstructed with 10 mm Dacron graft. Postoperative computed tomography angiography showed patent graft with good distal runoff. Literature review revealed that only 26 cases of congenital abdominal aortic aneurysm had been reported so far. None of them had inflow agenesis which can give false impression of pseudoaneurysm on preoperative evaluation. The case highlights the utility of additional complimentary investigations such as Doppler study in clinching diagnosis and helping plan and execute successful treatment in the difficult diagnostic scenario.

Diagnosis and treatment of congenital abdominal aortic aneurysm: a systematic review of reported cases

Background

Congenital abdominal aortic aneurysm (AAA) is distinctly rare in infants and children and carries a high mortality rate. Our objective was to summarize the experience of the diagnosis and treatment in patients with congenital AAA.

Methods

Reported cases of congenital AAA published prior to November 8, 2014, were identified through PubMed, EMBASE, Web of Science, and reference lists. All selected cases were evaluated for main clinical characteristics.

Results

Twenty-six cases of congenital AAA were identified in the English language literature. Congenital AAA occurred primarily in children under three years old, but it was also found in young adults and fetuses. With regards to the localization, the great majority of congenital AAA was infrarenal AAA. The majority of the AAA patients lacked specific symptoms, and a painless pulsatile abdominal mass was the most common clinical presentation. The diagnosis of AAA was based on ultrasound scanning in twenty-five cases, multi-slice spiral computed tomography angiography (MSCTA) in sixteen cases, and magnetic resonance angiography (MRA) in nine cases. Histopathological analyses were available in seven cases. Seven patients received conservative management. Surgical treatment was performed in seventeen cases, and open repair with an artificial graft was the main surgical intervention. The mortality associated with congenital AAA was high (30.76%). Ruptured aneurysm and renal failure were the main causes of death.

Conclusions

Good outcomes can be achieved in children with early identification of congenital AAA and individualized surgical repair with grafts.

Prenatal diagnosis and postnatal course of a giant abdominal aortic aneurysm: a case report

Congenital abdominal aortic aneurysms are rare but have chronic and life-threatening sequelae including hypertension, thromboses, and death. A fetal ultrasound at 27 weeks’ gestation diagnosed a giant abdominal aortic aneurysm. The patient delivered at another tertiary care center where pediatric cardiovascular surgery care was available. Her term 3096-g female infant developed hypertension, biventricular hypertrophy, and right kidney ischemia. She underwent surgical repair at 2 months of life but subsequently lost all residual renal function and was not a candidate for dialysis. Support was withdrawn and she expired. Although isolated fetal AAA is rare, prenatal diagnosis is feasible and facilitates early referral for multi-disciplinary postnatal care. Outcome depends on the size and location of the aneurysm as well as on peri-operative complications.

Extensive congenital abdominal aortic aneurysm and renovascular disease in the neonate

Primary congenital abdominal aortic aneurysm is an extremely rare entity, with only 15 patients reported in the literature. Options for repair are often limited secondary to branch vessel size and other anatomic limitations. We present a neonate diagnosed with an abdominal aortic aneurysm on prenatal ultrasound. A postpartum computed tomography angiogram revealed an extensive type IV thoracoabdominal aortic aneurysm extending to the aortic bifurcation and resulting in bilateral renal artery stenosis. The unique features of this patient and challenges in management are discussed.