Chronic intercostal neuralgia after placement of right ventricle to pulmonary artery conduit with prosthetic valve

BMJ Case Rep. 2021 Mar 2;14(3):e239264. doi: 10.1136/bcr-2020-239264.


Adults with congenital heart disease often have complex medical issues requiring individualised multidisciplinary care for optimising outcomes and quality of life. Chronic pain is an example. We report a rare case of intercostal neuralgia seemingly caused by irritation from a prosthetic valve in a right ventricle to pulmonary artery conduit in a patient with tetralogy of Fallot. Intercostal neuralgia is a painful disorder linked to nerve irritation or injury from trauma, infection or pressure. Although chronic postsurgical pain after cardiac surgery is prevalent, rarely the aetiology relates to valve irritation on a single intercostal nerve. After failing pharmacological therapy for 8 months, the neuralgia completely resolved after an ultrasound-guided neurolytic block with long-term effectiveness and improvement in patient satisfaction.

Keywords: cardiothoracic surgery; cardiovascular medicine; medical management; pain; pain (neurology).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cardiac Surgical Procedures*
  • Heart Ventricles
  • Humans
  • Neuralgia* / etiology
  • Pulmonary Artery / diagnostic imaging
  • Pulmonary Artery / surgery
  • Pulmonary Valve*
  • Quality of Life
  • Tetralogy of Fallot*