Giant Pulmonary Artery Aneurysm Associated to Severe Mitral Stenosis: Review and Case Report

Abstract

Pulmonary aneurysms are rare abnormalities of the pulmonary vessels that are often associated with pulmonary hypertension. However, the occurrence and treatment of this pathology are still unclear. A 33-year-old patient with a medical history of transcutaneous mitral commissurotomy was admitted with NYHA class III dyspnea and lower extremity edema. The clinical examination found the semiology of mitral stenosis and signs of both right and left heart failure. The electrocardiogram showed complete atrial fibrillation and right ventricle hypertrophy. Chest X-ray revealed cardiac hypertrophy and a prominent aspect of the left median arch reminiscent of a left pulmonary aneurysm. Doppler echocardiography found pure severe mitral stenosis (mitral valve area = 0.8 cm2), dilation of the pulmonary trunk (diameter = 74 mm), and its branches. The right heart chamber was also dilated, with significant tricuspid regurgitation and severe pulmonary hypertension (systolic pulmonary artery = 95 mmHg). The thoracic angioscan angiography revealed aneurysmal dilation of the trunk of the pulmonary artery and its branches without dilation of their distal parts (diameter of the pulmonary artery = 76 mm; Right pulmonary artery diameter = 51 mm, left pulmonary artery diameter = 40 mm). showed aneurysmal expansion of the pulmonary trunk and its branches without expansion of the distal portion (pulmonary artery diameter = 76 mm, right pulmonary artery diameter = 51 mm, left pulmonary artery diameter = 40 mm). Clinical symptoms improved with diuretic, anticoagulant, and analgesic treatment, and the patient was subsequently referred to cardiovascular surgery for mechanical mitral valve replacement and plastic surgery of the pulmonary artery. Pulmonary aneurysms are uncommon pathology that can be potentially life-threatening. Its clinical manifestations are usually nonspecific or asymptomatic and the appropriate treatment is a challenge, as there are no clear guidelines on the recommended treatment.