Main pulmonary artery aneurysm is an exceedingly rare entity. We present a case of main pulmonary artery aneurysm with patent ductus arteriosus in a sixty-year-old woman. The aneurysm was successfully treated with aneurysmectomy and primary anastomosis of the defect of the main pulmonary artery, and the patent ductus arteriosus was divided. The etiology, operative indication and surgical intervention of main pulmonary artery aneurysm are discussed along with a review of the literature.