Rupture and dissection in pulmonary artery aneurysms: Incidence, cause, and treatment—Review and case report

Abstract

continuous intravenous infusion of epoprostenol (prostacyclin) for 4 years, with the dosage increasing to 16 ng · kg–1 · min–1. Seven months previously, she underwent a right heart catheterization that revealed a pulmonary–systemic arterial pressure ratio (Pp/Ps) of 0.53. The electrocardiogram showed right ventricular hypertrophy. A posteroanterior chest x-ray film showed a left hilar mass indicating dilation of the left pulmonary artery. The patient was discharged without any further investigations because the physical examination disclosed no abnormalities. The next day, the patient was readmitted to the hospital because of worsening symptoms. The transthoracic echocardiogram revealed an enlarged main pulmonary artery with a diameter of 8 cm, a competent pulmonary valve, and massive pericardial effusion but failed to demonstrate pulmonary artery dissection. A computed tomogram confirmed dissection of the main pulmonary artery (Fig 1, A). She was transferred to the operating theater with signs of imminent cardiac tamponade and shock. Suprasystemic pulmonary pressures (systolic 120 mm Hg) were noted after induction of anesthesia with a Pp/Ps of 1.9. Surgical technique. Femoro-femoral bypass was established urgently followed by sternotomy and pericardiotomy, which revealed massive bloody pericardial effusion. At a blood temperature of 32°C with the heart beating, the pulmonary Since the first report of dissecting aneurysm of the pulmonary artery by Walshe in 1862 (cited by Watson1), 48 cases of pulmonary artery dissection have been reported.2-4 Dissection mostly develops in a pulmonary artery aneurysm associated with pulmonary hypertension and/or connective tissue disease. Forty-three cases were reported after death, whereas only 5 were diagnosed clinically, indicating that the event is highly lethal. In this report, we describe the surgical repair of dissection of an aneurysm in the main pulmonary artery resulting from primary pulmonary hypertension. Clinical summary. A 34-year-old woman was admitted to the emergency room with chest pain and shortness of breath. She had primary pulmonary hypertension for 10 years and had been receiving long-term therapy with coumarin and a RUPTURE AND DISSECTION IN PULMONARY ARTERY ANEURYSMS: INCIDENCE, CAUSE, AND TREATMENT—REVIEW AND CASE REPORT