Case Report

Our patient was a 52-year-old woman. She was admitted to our Cardiology Outpatient Clinic for dyspnea and increasing weight loss. She was in New York Heart Association (NYHA) functional class III at presentation. She had a AF rhythm in electrocardiography. Transthoracic echocardiography (TTE) showed severe aortic regurgitation and moderate mitral stenosis(mitral valve area:1.1cm ² ),and pressure gradient was mean 10mmHg at mitral valve. Left ventricle EF was 50%.Pulmonary arterial pressure was 50-55 mmHg and its diameter was 55mm. Her cardiac coronary arteriography(CAG) and cardiac catheterization were performed. It was confirmed that EF:50%. Coronary arteries were normal. Cardiac catheterization revealed severe aortic regurgitation and an aneurysm involving the main pulmonary artery(Figure 1).Pulmonary artery pressure was 50/23mmHg.

Figure 1

Figure 1

>She went under operation. Following a median sternotomy,pericard was opened longitudinally. Constricting layers of pericardium were separated if possible. We freed the pericardium in this order: first from the aorta and pulmonary artery, including the left ventricular outflow tract; then from the left and right ventricles and the left pulmonary vein orifices; and finally from the superior and inferior venae cavae. We explorated the giant main pulmonary artery aneurysm (Figure 2).

Figure 2

Figure 2

Our standart radiofrequency ablation technique was performed with Cardioblate BP(bipolar) Surgical Ablation Device (Medtronic 60821) Cross clamp duration lengthened 5 minutes with this accompanying procedure. After this step we performed mitral and aortic valvuloplasty procedures.

Comments

Pulmonary artery aneurysm is a rare lesion of the thoracic cavity(₁). Aneurysm of pulmonary artery is relatively rare clinical finding and appears mostly in association with significant cardiovascular or pulmonary abnormalities and is frequently caused by pulmonary hypertension(₂). Different etiologies have been reviewed, but idiopathic lesions without other symptoms are seldom reported(₁).

We present a case of a giant fusiform aneurysm of the main pulmonary artery which was associated with mitral and aortic valvular pathologies.

Aneurysm of the main pulmonary‘s natural history is not well understood and there are no clear guidelines regarding its optimal treatment(₃). Its diagnosis is not difficult(₂).

Usually, surgical interventions are suggested, but the long-term outcomes are not well established(₁). Although a surgical approach is generally considered life-saving by preventing rupture of the aneurysm, literature is unclear about possible rupture in the specific situation of a pulmonary artery aneurysm without a causative cardiac lesion and/or pulmonary hypertension. In fact, some reports suggest a conservative treatment for this specific entity(₄). The treatment can therefore be conservative as no clear guidelines to support interventional management(₅). However, the long-term follow-up is necessary.

Correspondence to

Doç. Dr. Ufuk YETKIN, 1379 Sok. No: 9,Burç Apt. D: 13 - 35220, Alsancak – IZMIR / TURKEY Tel: +90 505 3124906 , Fax: +90 232 2434848 e-mail: ufuk_yetkin@yahoo.fr