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

Abstract

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.

Pulmonary Artery Aneurysm: A Rarity and Surgical Enigma

“…PAAs secondary to congenital heart disease comprise the majority of reported cases, with patent ductus arteriosus, ventricular septal defect, and atrial septal defect being the most frequently described causes [ 3 ]. PAAs may also occur in the setting of pulmonary hypertension [ 4 ], which likely plays a role in the dilation of the pulmonary artery. In addition, PAAs due to infectious causes, such as syphilis, tuberculosis, and mucormycosis, have been described in reports [ 5 ].…”

Aneurisma de arteria pulmonar: una revisión y dos casos ilustrativos

“…El ecocardiograma puede revelar un aumento del diámetro del tronco de la AP mayor al límite superior de la normalidad observado en la ventana del tracto de salida del ventrículo derecho/AP, así como signos indirectos de la presencia de un AAP (2).…”

“…Un aneurisma verdadero es la dilatación focal de un vaso sanguíneo que compromete las tres capas que componen su pared (1), a diferencia de los pseudoaneurismas que no cumplen esta regla. Los procesos aneurismáticos de la arteria pulmonar (AAP) ocurren en el tronco principal, que normalmente tiene un diámetro de hasta 29 mm en hombres y 27 mm en mujeres, y/o en alguna de sus ramas (2). A pesar de ser una patología conocida desde hace más de cien años, aún hay discrepancias en la literatura sobre los parámetros para definir la presencia de un AAP; algunos autores consideran AAP cuando es mayor de 40 mm (3), y otros tienen en cuenta un diámetro troncular mayor de 45 mm y/o mayor de 30 mm en una de las ramas de la arteria pulmonar (AP) (4).…”