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Interact Cardiovasc Thorac Surg. 2016 May; 22(5): 698–699.
Published online 2016 February 3. doi:  10.1093/icvts/ivv399
PMCID: PMC4892141

Idiopathic aneurysm of the pulmonary artery in a patient with coronary disease

CLINICAL PROBLEM

When intracardiac or extracardiac shunts, chronic heart or lung disease, arterial disease of the pulmonary artery (PA) or an extensive atheromatosis or arteriosclerosis are excluded, idiopathic pulmonary artery aneurysm (PAA) is taken into consideration. Sporadic individual cases of idiopathic PAA [13] can be found in the literature [13]. Natural course of idiopathic PAA (which can reach enormous dimensions) or the corresponding therapeutic procedures are not clearly defined. In asymptomatic patients, no guidelines can be found indicating whether surgical or conservative treatment should be applied [14]. The incidence of PAA is 1 case per 13 700 autopsy cases [2]. Several cases can be found in the literature (with follow-up from 24 years [3] to 39 years [4]) with idiopathic PAA and without rupture. There are no data about cut-off dimensions of PAA diameters, which indicate the risk of rupture and, even more importantly, the potential risk of doing surgery in these cases.

CASE DESCRIPTION

A case of idiopathic asymptomatic PAA with associated coronary artery disease is reported. The patient is a 72-year old male with intermittent pain behind the chest bone and three vessel coronary artery disease verified by coronary angiography. Transthoracic and transoesophageal echocardiography and computed tomography (MDCT) were performed. Electrocardiogram and physical examination were normal. Chest X-ray suggested a discrete pronounced shadow in the projection of the left hilus. Transthoracic two-dimensional echocardiography showed that the left and right heart chambers are within normal size and function, and also showed competent valves and turbulent colour flow Doppler at the level of the pulmonary valve without high pressure gradient or pulmonary regurgitation with vague contours of the wall of the PA.

Transoesophageal echocardiography showed that the main trunk of the PA was dilated up to 4.7 cm. Dimension of the right branch was 2.1 cm and it was very difficult to visualize the wall of the left branch, which was 5.3 cm in aneurysmatic form. MDCT showed that the main trunk of PA was 4.6 cm, the right branch PA measured 2.35 cm and the left branch PA measured 5.26 cm (Fig. (Fig.11).

Figure 1:
MDCT showed an aneurysm of the main trunk and the left branch of PA. PA: pulmonary artery.

Preoperative coronary angiography revealed stenosis of the left main coronary artery up to 40% subocclusion of the left anterior descending coronary artery and right coronary artery. Inflammatory, infectious aetiologies and collagen vascular disease were excluded by laboratory tests. There were no history data for arthritis or obvious lesions of Behcet's disease.

The treatment of choice for this aneurysm of the PA is published below.

Conflict of interest: none declared.

REFERENCES

1. Vural AH, Turk T, Ata Y, Goncu T, Ozyazicioglu A Idiopathic asymptomatic main pulmonary artery aneurism: surgery or conservative management? A case report. Heart Surg Forum 2007;10:E273–5. [PubMed]
2. Deb SJ, Zehr KJ, Shields RC Idiopathic pulmonary artery aneurysm. Ann Thorac Surg 2005;80:1500–2. [PubMed]
3. Arnaoutakis G, Nwakanma L, Conte J Idiopathic pulmonary artery aneurysm treated with surgical correction and concomitant coronary artery bypass grafting. Ann Thorac Surg 2009;88:273–5. [PubMed]
4. Van Rens MT, Westermann CJ, Postmus PE, Schramel FM Untreated idiopathic aneurysm of the pulmonary artery; long-term follow-up. Respir Med 2000;94:404–5. [PubMed]

Articles from Interactive Cardiovascular and Thoracic Surgery are provided here courtesy of Oxford University Press