Pulmonary Artery Dissection: A Case Treated by Homograft Replacement

Abstract

Pulmonary artery dissection was diagnosed in a 32-year-old man who was admitted to the emergency department with intense chest pain. He had a history of pulmonary balloon valvuloplasty for congenital pulmonary stenosis at the age of 7 and no pulmonary hypertension. The operation was performed with cardiopulmonary bypass. The dissected pulmonary arterial trunk was removed with the distorted valve, and replaced with a pulmonary artery homograft. The postoperative course was uneventful. Histologic examination revealed medionecrosis. Pulmonary artery dissection is a rare but highly lethal pathology. In the absence of pulmonary hypertension, surgical treatment with homograft replacement can lead to excellent results.

Pulmonary artery dissection complicating aortic dissection in a patient with bicuspid aortic valve and aortic coarctation

“…Pulmonary artery dissection is a rare disease with a high mortality, with predominately case reports noted in the literature [1] , [2] , [3] , [4] , [5] . It most commonly occurs secondary to pulmonary arterial hypertension, but has been reported with right heart endocarditis, amyloidosis, catheterization, and chronic pulmonary artery inflammation [1] , [2] , [3] .…”

“…Treatment of pulmonary aortic dissection is not well defined. However, medical management of resulting pulmonary hypertension, surgical repair of entry site, lobectomy, and transplantation have all been briefly described [2] , [3] , [5] . Aortic and pulmonary artery dissection should be considered in patients with chest pain or shortness of breath with any of the above risk factors.…”

Successful beating‐heart repair of pulmonary artery dissection using a composite valve‐tube graft

“…While heart‐lung transplantation has been described for PAH patients with PA dissection, 7,8 psychosocial factors proved a significant barrier for our patient. Excision and replacement of the dissected PA aneurysm segment has also been reported, using a prosthetic graft, 9 homograft, 10 or stentless xenograft 11 . However, there is no consensus on which technique is preferred, or at what diameter PA aneurysms should be repaired.…”

Succesfull management of a giant pulmonary artery aneurysm associated with severe congenital pulmonary valve stenosis in an adult patient

“…This might have slowed the evolution to heart failure, explaining the late symptomatology, but same criteria as for aortic aneurysms to decide surgical intervention, consisting in a diameter of more than 5,5cm, symptoms, more than 0,5cm diameter increase in 6 months, complications, etc 1 . A careful management is generally recommended, because even if the rupture risk is low, there are also other possible fatal complications that may occur, like pulmonary embolism, heart failure and compression of the surrounding structures including the coronary arteries 13 . Duijinhouwer et al concluded in a recent review and analysis that pulmonary hypertension in congenital heart disease (CHD), a fast diameter growth (>2 mm/ year), tissue weakness mostly due to infection are the most frequent predisposing factors for dissection, and in the rest of the cases, the risk is low 3 .…”