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Interact Cardiovasc Thorac Surg. 2016 May; 22(5): 699–700.
Published online 2016 April 21. doi:  10.1093/icvts/ivw100
PMCID: PMC4892170

Treatment solution by Aparci and Uz

We have read the article by Tomic et al. with great interest [1]. Authors presented a case of idiopathic asymptomatic pulmonary artery aneurysm with associated coronary artery disease. Idiopathic pulmonary artery aneurysm (PAA) may present with non-specific signs and symptoms such as exertional dyspnoea, chest pain, and cough which are mainly due to compression and mass effect, unless it is complicated with rupture or dissection [2]. Presence of these signs and symptoms may indicate the surgical treatment of pulmonary artery aneurysm, especially for giant aneurysms up to 60 mm in size [3]. Additionally, pericardial effusion may be one unusual complication of idiopathic PAA. It is probably due to interruption of cardiac lymphatic drainage by the enlargement of pulmonary artery base. If it is asymptomatic and detected incidentally, it may be followed up conservatively [4]. Otherwise, if it is due to the dissection of PAA, it must be treated immediately. Either elective or immediate surgical treatment of pulmonary artery by using Dacron grafts results in better clinical outcomes unless the patient's right and left ventricular functions have deteriorated [5]. The most interesting point of this case is coexistence of three-vessel coronary artery disease with the involvement of the left main coronary artery and the idiopathic PAA. Surgical revascularization is indicated in this case. Surgical treatment of PAA simultaneously with the coronary bypass grafting may be the best curative option in this case. Since the right and left ventricular functions and dimensions were within normal limits yet and the probability of post-operative complications were very low. If severe coronary artery disease or chest pain did not coexist, patient might have been followed up conservatively. Transthoracic echocardiography is the method of choice in the management of idiopathic PAA. It may easily be diagnosed by routine or screening transthoracic echocardiography examination and followed up by serial echocardiography even from an early age. In conclusion, idiopathic PAA may be asymptomatic and detected incidentally unless it is presented with the signs and symptoms of compression or rupture. The decision regarding clinical follow-up or surgical treatment of idiopathic PAA mainly depends on the severity of the signs and symptoms or the presence of severe comorbidity, as in this case. Surgical treatment of idiopathic PAA will be clinically satisfactory if the left and right ventricular functions are normal.

Conflict of interest: none declared.

References

1. Tomic S, Nikolic A, Jovovic L, Gradinac S Idiopathic aneurysm of the pulmonary artery in a patient with coronary disease. Interact CardioVasc Thorac Surg 2016;22:698–700. [PMC free article] [PubMed]
2. Kharge J, Singh AP, Raghu TR, Hegde M, Bharata A, Manjunath CN Idiopathic dilatation of the pulmonary artery-a case report. Echocardiography 2013;30:E265–8. [PubMed]
3. Seguchi M, Wada H, Sakakura K, Kubo N, Ikeda N, Sugawara Y et al. Idiopathic pulmonary artery aneurysm. Circulation 2011;124:e369–e370. [PubMed]
4. Ercan S, Dogan A, Altunbas G, Davutoglu V Giant pulmonary artery aneurysm: 12 years of follow-up. Case report and review of the literature. Thorac Cardiovasc Surg 2014;62:450–2.
5. Vistarini N, Aubert S, Gandjbakhch I, Pavie A Surgical treatment of a pulmonary artery aneurysm. Euro J Cardiothorac Surg 2007;31:1139–1141

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