Idiopathic Asymptomatic Main Pulmonary Artery Aneurysm: Surgery or Conservative Management? A Case Report

Vural, A. Hakan; Türk, Tamer; Ata, Yusuf; Goncu, Tugrul; Özyazicioğlu, Ahmet

doi:10.1532/hsf98.20061199

Cited by 31 publications

(16 citation statements)

References 12 publications

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“…14 Overall, idiopathic PAA seem to be a relatively benign condition, and conservative observation may be reasonable when there is normal PA pressure, in contrast to patients with aneurysms of the aorta. 44 In case of PAH, treatment should include calcium channel blockers, diuretics, and anticoagulants, and patients may benefit from the use of vasoactive substances such as endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, and prostacyclin derivatives. 45 Nevertheless, the majority of patients with normalized pressure still show an increase in PAA diameter.…”

Section: Conservative and Interventional Treatmentmentioning

confidence: 99%

“…10,34,35,44 In case of symptomatic pulmonary valve regurgitation and right ventricular dilatation, the timing of surgical intervention should be determined by changes in right ventricular size and function rather than the size of the PAA itself. 10,34 Moreover, in cases of PAH or an underlying tissue disease, surgery seems to be the treatment of choice.…”

Section: Indication For Surgical Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Aneurysms of the Pulmonary Artery

Kreibich¹,

Siepe²,

Kroll³

et al. 2015

Circulation

193

294

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Section: Conservative and Interventional Treatmentmentioning

confidence: 99%

Section: Indication For Surgical Treatmentmentioning

confidence: 99%

Aneurysms of the Pulmonary Artery

Kreibich¹,

Siepe²,

Kroll³

et al. 2015

Circulation

193

294

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“…Although there are no clear guidelines for optimal treatment, surgery is indicated in patients at a risk of dissection or rupture. Hemoptysis generally indicates instability of the aneurysm, and indicates the need for surgical intervention [4]. The optimal elective surgical treatment is the resection of the aneurysm and graft replacement.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, patients with \60 mm aneurysms, low pulmonary pressure, absence of congenital or acquired significant right shunt or not associated with collagenopathies are considered at low risk, and conservative management is preferred [1][2][3][4].…”

Section: Discussionmentioning

confidence: 99%

Unusual and voluminous pulmonary trunk aneurysm

2011

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A 65-year-old woman, with hypertension and dyslipidemia, was admitted to our department because of effort dyspnea. The electrocardiogram and physical examination were normal. Transthoracic two-dimensional echocardiography (2DE) showed left and right cardiac chambers with normal dimensions and function (LVEF 65%), mild concentric left ventricle hypertrophy, mild valvular pulmonic stenosis (the continuous-wave Doppler showed a peak velocity of 2.93 m/s, which is consistent with a systolic gradient of 34 mmHg) and aneurysmal dilatation of the main pulmonary artery with extension to the bilateral main branches (Fig. 1). An exercise ECG test showed an inappropriate increase in heart rate and blood pressure at low exercise workloads without ST segment abnormalities. The exercise level was inadequate to test cardiac reserve. A computed tomography (CT) coronary angiography was performed. It showed a voluminous aneurysm (77.6 mm) of the pulmonary artery (Fig. 2), without other cardiac abnormalities. DiscussionPulmonary artery aneurysm (PAAs)-defined as PA dilation greater than 4 cm-is a rare condition, regardless of the cause. The etiology of PAAs can be congenital or acquired. Congenital aneurysms are usually associated with congenital heart diseases causing pulmonary hypertension, and persistent ductus arteriosus is the most frequent. Other congenital causes include atrial and ventricular defects.Acquired causes can be idiopathic or associated with other processes, such as infections (tuberculosis, syphilis), traumatisms, pulmonary valvular stenosis, or diseases affecting collagenous tissue [1,2].In rare cases, when the PAA is not due to a functional or structural anomaly of the cardiovascular system, it is known as an idiopathic PAA.Clinical presentation of a PAA varies. It can be asymptomatic, being a chance finding in a chest X-ray study, echocardiography or computed tomography. In symptomatic patients, dyspnea, hemoptysis and chest pain are the most frequent complaints [1,3].

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“…Congenital dilated pulmonary trunk diagnosed in 6 patients per 1000 patients diagnosed with other heart defect. The acquired pulmonary aneurysm is in a pulmonary hypertension in the course of a mitral stenosis; followed by lung cancer; tuberculosis aneurysm Rasmussen; syphilis or fungal infections; vascular inflammatory, such as disease-Hughes Stovina, Behcet's syndrome, Marfan syndrome [2]. In June 2016 was admitted 74-year-old to coronary artery bypass implantation.…”

mentioning

confidence: 99%

Idiopathic Pulmonary Trunk Aneurysm in 74-Year-Old Patient

Wieteska¹,

RyfiAAski²,

GAAowacki³

et al. 2017

Vasc Med Surg

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Pulmonary artery aneurysm is an enlargement of the pulmonary artery by more than 50% compared to its normal diameter. Pulmonary aneurysm is estimated at 1:14,000 cases of autopsy [1]. Congenital dilated pulmonary trunk diagnosed in 6 patients per 1000 patients diagnosed with other heart defect. The acquired pulmonary aneurysm is in a pulmonary hypertension in the course of a mitral stenosis; followed by lung cancer; tuberculosis aneurysm Rasmussen; syphilis or fungal infections; vascular inflammatory, such as disease-Hughes Stovina, Behcet's syndrome, Marfan syndrome [2]. In June 2016 was admitted 74-year-old to coronary artery bypass implantation.During cardiological diagnostics in Czestochowa, when the patient was treated angioplasty with implantation an antimitotic stent to right coronary artery after during non-ST elevation myocardial infarction, the chest radiology scan highlighted enlargement left pulmonary hill. The patient was treated undergoing hypertension and paroxysmal atrial fibrillation so far. The patient did not complain of cough or hemoptysis. From the time of myocardial infarction was stable cardiac CCS class II and NYHA II. In a transthoracic echocardiography (TTE) anatomy of the right ventricle and pulmonary valve were normal, no pulmonary hypertension. A chest computed tomography (CT) scan the left pulmonary artery was 50 mm in diameter (Figure 1). Euro SCORE operative risk was high and reached 8 points (3 for age, 3 for LVEF 47 %, 2 for myocardial infarction <90 days) with a logistic score of 37. Optimal treatment of pulmonary arterial aneurysm has not been established. If pulmonary aneurysm is >55 mm, or a fold increase of >5 mm within six months, with thrombus in the aneurysm sack are their clinical symptoms or dissection is recommended surgery treatment [3][4][5]. On 30-06-2016 we have implanted two bypasses: LIMA >LAD and Ao >OM1. After opening the patient's chest we observed large aneurysm of pulmonary trunk. We backed out of surgery treatment this aneurysm because it was very thin wall, covered for normally size ascendant aorta. It was taken very aortic wall to aim was to doing nearest anastomosis. All heart was in solid, hard adhesions with pericardium. It make difficult for identification coronary arteries.Anatomically pulmonary trunk aneurysm was passed on the left pulmonary artery. The right pulmonary artery was normal size. The patient was extubated as planned, with good respiratory and circulatory function. Postoperative hospitalization time was not complicated. The patient was extubated as planned, with good respiratory and circulatory function. Follow-up examination supplementation was subsequently started. The patient underwent a standard process of in-hospital rehabilitation, and from the third post-operative day was able to walk down the hospital hallway. On the post-operative day, the patient was discharged in very good condition; the wound was healed by primary intention. On discharge, long-term antiplatelet therapy -clopidogrel, warfarin, atorvastatin, angiotensin conver...

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Idiopathic Asymptomatic Main Pulmonary Artery Aneurysm: Surgery or Conservative Management? A Case Report

Cited by 31 publications

References 12 publications

Aneurysms of the Pulmonary Artery

Aneurysms of the Pulmonary Artery

Unusual and voluminous pulmonary trunk aneurysm

Idiopathic Pulmonary Trunk Aneurysm in 74-Year-Old Patient

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