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Review
. 2020 Sep;17(3):143-148.
doi: 10.5114/kitp.2020.99078. Epub 2020 Sep 23.

Pulmonary artery aneurysm as a result of group 2 pulmonary artery hypertension in a patient with significant mitral and aortic valve disease - review and case report

Karolina Marzec  1 , Maria Jaworska-Wilczyńska  1 , Konrad Grobelny  1 , Piotr Kołsut  2 , Ilona Michałowska  3 , Patrycjusz Stokłosa  1 , Tomasz Hryniewiecki  1
Affiliations
Review

Pulmonary artery aneurysm as a result of group 2 pulmonary artery hypertension in a patient with significant mitral and aortic valve disease - review and case report

Karolina Marzec et al. Kardiochir Torakochirurgia Pol. 2020 Sep.

Abstract
in English, Polish

Aneurysms are uncommon, but potentially life-threatening abnormalities of the pulmonary arteries. Aneurysm of the main pulmonary artery (MPA) defined as MPA diameter over 40 mm was reported in 1 : 14 000 autopsies. The most frequent location is the main pulmonary artery (89% of cases), whereas the maximum described diameter is 106-170 mm. Clinical manifestations are usually nonspecific or asymptomatic. Right heart failure symptoms, pulmonary regurgitation, trachea or bronchi compression or pulmonary emboli caused by enlarged MPA are the most commonly described clinical manifestations. Pulmonary artery aneurysm dissection is an uncommon complication but associated with a high mortality rate. Unfortunately, guidelines regulating the optimal time for the surgical intervention still have not been developed. We present the history of 76-year-old patient suffering from an aneurysm of the pulmonary artery (74 × 61 mm), as well as mitral and aortic valve disease, who was successfully operated on in our hospital.

Tętniaki są rzadkimi, ale potencjalnie zagrażającymi życiu patologiami tętnicy płucnej. Częstość ich występowania szacuje się na 1 : 14 000 autopsji. Zgodnie z definicją tętniaka pnia tętnicy płucnej rozpoznaje się, gdy średnica naczynia przekracza 40 mm. Najczęstszą jego lokalizacją jest pień płucny (89% przypadków), podczas gdy największy opisany dotąd tętniak miał średnicę 106–170 mm. Objawy są najczęściej niespecyficzne lub choroba przebiega bezobjawowo. Prawokomorowa niewydolność serca, niedomykalność zastawki płucnej, ucisk na tchawicę, oskrzela lub zator płucny spowodowany przez ucisk powiększającego się tętniaka są najczęstszymi objawami zgłaszanymi przez chorego. Rozwarstwienie tętniaka tętnicy płucnej jest bardzo rzadkim powikłaniem, ale obarczonym wysoką śmiertelnością. Niestety dotychczas nie zostały opracowane żadne wytyczne dotyczące postępowania u pacjentów z tą chorobą. Przedstawiamy przypadek 76-letniego pacjenta z tętniakiem tętnicy płucnej (74 × 61 mm), wadą zastawki aortalnej i mitralnej, który został zoperowany w naszym ośrodku.

Keywords: pulmonary artery aneurysm; pulmonary hypertension.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Algorithm for management for pulmonary artery aneurysm
Figure 2
Figure 2
Echocardiographic five chamber view showing elevated gradient across aortic valve (64.5/37.1 mm Hg)
Figure 3
Figure 3
Echocardiographic parasternal short axis view revealing stenosis of bicuspid aortic valve – aortic valve area 1.1 cm2
Figure 4
Figure 4
Four chamber cardiac echocardiography showing elevated gradient across mitral valve (21.5/7.2 mm Hg)
Figure 5
Figure 5
Echocardiographic parasternal short axis view demonstrated stenosis of mitral valve – mitral valve area 1.4 cm2
Figure 6
Figure 6
Parasternal short cardiac echocardiography image demonstrating large dilatation of pulmonary artery
Figure 7
Figure 7
echocardiographic five chamber view showing increased tricuspid regurgitation peak gradient suggesting pulmonary hypertension
Figure 8
Figure 8
Computed tomography scan showing a large aneurysm of the main pulmonary artery in longitudinal – section
Figure 9
Figure 9
Three-dimensional reconstruction of the heart and the massively dilated main pulmonary artery
Figure 10
Figure 10
Computed tomography scan revealing a large aneurysm of the main pulmonary artery in cross – section
See this image and copyright information in PMC

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