RESUMO
Mycotic aneurysms are dilatations of an artery, a rare but severe complication arising from infectious obliteration of the vessel wall. Thoracic aneurysms often present with unspecific symptoms and multiple diagnostic and therapeutic challenges. In an advanced state, they have an increased risk of perforation and a high mortality rate. The surgical therapeutic approach has a high perioperative complication rate. In this study, we report a case of a thoracic mycotic aortic aneurysm in an immunocompromised pediatric patient caused by Klebsiella pneumoniae bacteremia. A combination of prompt antibacterial treatment and minimally invasive stent implantation showed a good outcome, avoiding possible severe surgical problems.
RESUMO
Intravascular lithotripsy (IVL) is a novel method based on pulsatile ultrasonic pressure waves specifically aimed to modify circumferential and transmural calcium plaques. We report on the successful application of a shockwave IVL catheter® in a child with chronic thromboembolic pulmonary hypertension due to calcified thrombi in both lower lobes. Compared to conventional high-pressure balloon angioplasty, a significant perfusion-improvement was achieved with a shockwave IVL catheter® (4 mm) of the treated right pulmonary artery branch. Furthermore, subsequent surgical thrombectomy was reported to be considerably easier for the shockwave-treated thrombotic areas than the high-pressure balloon-only-treated thrombus. In conclusion, the shockwave IVL catheter® may be a promising option in chronic thromboembolic lesions in PA (pulmonary artery) position, and furthermore might be an option when treating children.
