In utero fetal left ventricular rupture and pseudoaneurysm formation: a case report

BMC Pregnancy Childbirth. 2021 May 20;21(1):393. doi: 10.1186/s12884-021-03869-4.

Abstract

Background: Cardiac ventricular aneurysms affect 1 in 200,000 live births. To the best of our knowledge, no reported cases of a left ventricular pseudoaneurym and in utero rupture exist to guide optimal management.

Case presentation: We present a case of fetal left ventricular rupture with a large pericardial effusion, cardiac tamponade and subsequent pseudoaneurysm formation with concerns for a poor prognosis. Interventional drainage of the pericardial effusion led to resolution of tamponade and significant improvement in fetal condition. A multidisciplinary team was utilised to plan birth to minimise risk of pseudoaneurysmal rupture and a catastrophic bleed at birth.

Conclusion: For similar cases we recommend consideration of birth by caesarean section, delayed cord clamping and a prostaglandin E1 infusion, to reduce the systemic pressures on the left ventricle during transition from fetal to neonatal circulations, until definitive surgical repair. In this case, this resulted in a successful outcome.

Keywords: Cardiac pseudoaneurysm; Interventional drainage; Perinatal cardiology; Ventricular rupture.