Pulmonary artery aneurysms: Preoperative, intraoperative, and postoperative findings

Abstract

Background Pulmonary artery aneurysms (PAAs) are a rare but potentially lethal cardiovascular pathology. PAAs tend to develop in young patients with no gender discrepancy; they are most often associated with congenital heart disorders but also with systemic infections, vasculitis, pulmonary arterial hypertension, chronic pulmonary embolism, and malignancies. Dissection and rupture carry significant morbidity and mortality, thus patients require careful management, especially those with associated pulmonary hypertension. Given the rarity of this condition, physicians have yet to establish standard treatment guidelines. Most studies published to date are case reports with one or two patients; here, we describe our experience with six cases of large PAAs treated surgically at our institution. Methods We identified and retrospectively analyzed clinical data for patients who underwent surgery for PAAs between 2009 and 2017. Results The average age at surgery was 59.73 years, five patients were females, and 83.3% had baseline hypertension. Systolic murmurs were the most common clinical finding. The average aneurysmal size was 65.0 mm. We repaired the PAA with a woven Dacron graft (22‐26 mm) in four patients. We performed concomitant pulmonary valve procedures on five patients: four replacements and one repair. Mean pump and cross‐clamp times were 108.5 and 65 minutes. Operative and 30‐day mortality was 0%. Average length of stay was 10.5 days. Conclusions Postoperative mortality was 0%; all patients showed improvement of symptoms after surgery. These findings confirm that PAA repair has an acceptable risk profile in select patients.

Case Report: Surgical management of idiopathic pulmonary aneurysms and review surgical approaches

“…The functionality of the pulmonary valve needs to be evaluated to determine if it is affected. If the valve function is normal and only the annulus is enlarged, a procedure similar to David's ( 16 ) or Devega's ( 15 ) can be performed, preserving as much function of the pulmonary valve as possible; if the valve function is abnormal, a bioprosthetic pulmonary valve is also a good option ( 12 , 18 ) ( Figure 3 ).…”