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Neth Heart J. 2010 October; 18(10): 503–504.
PMCID: PMC2954304

Giant, high pressure pulmonary artery aneurysm in a grand multiparous woman

A 33-year-old woman in the ninth week of her eighth pregnancy was referred to our clinic because of dyspnoea on mild exertion. She had had seven uncomplicated pregnancies in her past medical history. Physical examination revealed a grade 3/6 systolic murmur in the pulmonary area. The electrocardiogram showed right bundle branch block and right ventricular strain pattern. Transthoracic echocardiogram revealed an aneurysm of the pulmonary artery with extremely high pulmonary artery pressure and right ventricular hypertrophy (figure 1). She was offered medical abortion. Cardiovascular magnetic resonance imaging demonstrated aneurysmatic dilatation of the main pulmonary artery with extension to the bilateral main branches (figure 2). Subsequent cardiac catheterisation confirmed aneurysmatic dilatation of the main pulmonary artery without any shunt (figure 3). After other possible causes were all sought carefully in detail, the diagnosis of idiopathic pulmonary hypertension with pulmonary artery aneurysm was made in this patient. Interestingly, she had been completely free of symptoms during her previous pregnancies. She refused surgical treatment due to the risks of the operation. She has been followed up medically with bosentan and warfarin for two months.

Figure 1
Transthoracic echocardiography, parasternal short-axis view showing the measurement of the pulmonary artery aneurysm of approximately 7.4 centimetres. The white arrow indicates the pulmonary valves. Estimated pulmonary artery systolic pressure was 130 ...
Figure 2
Cardiovascular magnetic resonance imaging showing A) the aneurysm of the pulmonary artery, its position to the aorta, B) extension to the main branches. AA=ascending aorta, DA=descending aorta, PAA=pulmonary artery aneurysm, RPA=right pulmonary artery, ...

Here we present a rare and interesting case of severe pulmonary hypertension accompanied by a giant pulmonary artery aneurysm. It is well known that both conditions have high mortality rates during pregnancy but, unexpectedly, the patient tolerated seven pregnancies well.1,2

Figure 3
Angiographic evaluation of PAA. A) Lateral view showing the aneurysm and pulmonary valves. B) Anteroposterior view showing the aneurysm and RPA. PV=pulmonary valves, PAA=pulmonary artery aneurysm, RPA=right pulmonary artery.

References

1. McCaffrey RN, Dunn LJ. Primary pulmonary hypertension in pregnancy. Obstet Gynecol Surv. 1964;19:567-91. [PubMed]
2. Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol. 1998;31:1650-57. [PubMed]

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