Untreated idiopathic aneurysm of the pulmonary artery; long-term follow-up

Rens, Marcel Th. M. van; Westermann, C. J. J.; Postmus, Pieter E.; Schramel, Franz M.N.H.

doi:10.1053/rmed.1999.0750

Cited by 41 publications

(24 citation statements)

References 6 publications

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“…A case report suggested that the long-term outcome of pulmonary artery aneurysm was favorable without surgical treatment. 4 It is unclear whether there is a size hinge point similar to aortic aneurysms in which the risk of complication increases. Although some recommend medical treatment for such patients, 4 others recommend surgical intervention for those with an aneurysm that has a diameter of 60 mm or greater.…”

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confidence: 99%

Idiopathic Pulmonary Artery Aneurysm

et al. 2011

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A 45-year-old man was referred to our hospital after a prolonged history of exertional dyspnea. Clinical examination revealed systolic and diastolic heart murmurs without any systolic click in the second right sternal border. Chest x-ray showed pulmonary artery dilation ( Figure 1). Multidetector computed tomography showed a huge pulmonary artery aneurysm Ϸ70 mm in diameter (Figure 2). Transthoracic echocardiography showed a huge aneurysm of the pulmonary artery by 2D echocardiography (Figure 3). There was no significant tricuspid regurgitation in either the 4-chamber view or the short-axis view, and pulmonary regurgitation due to dilatation of pulmonary annulus was seen by color-Doppler echocardiography (Movies I through III in the online-only Data Supplement). Cardiac catheterization did not show any pressure gradient between pulmonary artery and right ventricle or any sign of pulmonary hypertension. We diagnosed an idiopathic pulmonary artery aneurysm in this patient.Aneurysmectomy of the pulmonary main trunk with a 24-mm synthetic graft and valvuloplasty of an enlarged pulmonary annulus were performed ( Figure 4). The pathological examination did not show any sign of cystic medial degeneration ( Figure 5).Pulmonary artery aneurysm is a rare anomaly found in Ϸ1 of every 14 000 autopsies; most of these anomalies are present in the main pulmonary artery. 1 The cause of pulmonary artery aneurysm may be idiopathic; however, other causes include congenital shunt disease, syphilis, atherosclerosis, trauma, and pulmonary hypertension. 2 In Ͼ50% of the postmortem cases, pulmonary aneurysms were associated with congenital heart disease, most frequently patent ductus arteriosus. In the remaining reported cases, such aneurysms were associated mainly with secondary acquired lesions, such as syphilis and cystic medial degeneration. In our case, however, no pathological abnormality was shown by the histological sections of aneurysmal wall.Idiopathic pulmonary arterial aneurysm is considered to be a possible cause of rupture, dissection of pulmonary artery, or cardiac sudden death. 3 Most of the pulmonary artery dissections are diagnosed only at necropsy, because of their high mortality rate. The natural history of an untreated idiopathic pulmonary artery aneurysm has not been well elucidated. A case report suggested that the long-term outcome of pulmonary artery aneurysm was favorable without surgical treatment. 4 It is unclear whether there is a size hinge point similar to aortic aneurysms in which the risk of complication increases. Although some recommend medical treatment for such patients, 4 others recommend surgical intervention for those with an aneurysm that has a diameter of 60 mm or greater. 2 Disclosures

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confidence: 99%

Idiopathic Pulmonary Artery Aneurysm

et al. 2011

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“…On the other hand, conservative treatment is advocated when there is no left-to-right cardiac shunt or significant pulmonary hypertension [6]. …”

Section: Discussionmentioning

confidence: 99%

Case report and management approach in idiopathic pulmonary arteries aneurysm

Haj‐Yahia

Sbaih

Bali

et al. 2018

J Cardiothorac Surg

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BackgroundIdiopathic pulmonary artery aneurysm is a rare anomaly with only a handful reports in the literature. It is often asymptomatic, while the first presentation could be severe hemoptysis or death.Surgical intervention needs to be planned carefully with a multidisciplinary team approach to secure optimal outcome. We hope to spread our experience with such cases and to encourage other surgeons worldwide to deal surgically with these cases when its indicated.Case presentationA 47 years old man presented to our institution after three episodes of hemoptysis, echo demonstrated good left ventricle (LV) systolic function, normal right ventricle (RV) size and function, Chest computed tomography (CT) revealed aneurysmal dilatation with pending rupture of the pulmonary artery trunk (4.5 cm), the left pulmonary artery (6 cm) and the right pulmonary artery (2.3 cm). The patient successfully underwent replacement of Pulmonary artery trunk, left pulmonary artery and right pulmonary artery by Wovex Prosthetic graft (28 mm). The patient discharged home on the eight postoperative day in good clinical condition .ConclusionWith this case report we wish to emphasize the need for a careful multidisciplinary approach given the complex and rare nature of the reported pathology.Electronic supplementary materialThe online version of this article (10.1186/s13019-018-0791-9) contains supplementary material, which is available to authorized users.

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“…7 The pathological criteria for idiopathic aneurysm are described as, (1) Dilation of pulmonary trunk (involvement of arterial tree might or might not be present), (2) Absence of extra-or intra-cardiac shunts, (3) Absence of pulmonary disease or chronic cardiac disease, and (4) More than minimal atheromatosis or pulmonary vascular tree arteriosclerosis or absence of arterial disease. 8 According to these criteria, the patient had idiopathic pulmonary artery aneurysm. PAAs can be classified into proximal (or central) PAAs and peripheral PAAs.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Pulmonary Artery Aneurysm (Paa) Mimicking as Cavity, a Rare Entity

Kansal¹,

Goyal²,

Kumar³

et al. 2016

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Aneurysms of Pulmonary Arteries (PAs) and trunk are rare. Infection, structural cardiac anomalies, structural vascular anomalies and pulmonary hypertension are among the most common underlying risk factors for developing Pulmonary Artery Aneurysms (PAAs). Idiopathic, isolated aneurysms also do occur, but they are very rare entity. Owing to advances in diagnostic imaging methods such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and echocardiography, nowadays reports and identification of these clinical entities have increased. We report a 62-year-old female presented to our outpatient department with complaint of haemoptysis and was diagnosed to have left Pulmonary Artery Aneurysm (PAA).

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Untreated idiopathic aneurysm of the pulmonary artery; long-term follow-up

Cited by 41 publications

References 6 publications

Idiopathic Pulmonary Artery Aneurysm

Idiopathic Pulmonary Artery Aneurysm

Case report and management approach in idiopathic pulmonary arteries aneurysm

Idiopathic Pulmonary Artery Aneurysm (Paa) Mimicking as Cavity, a Rare Entity

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