Abstract
A 44-year-old lady was transferred to our hospital with an overnight history of central chest pain radiating to her back and increasing shortness of breath on exertion. This is on a background of having been diagnosed with a main pulmonary artery aneurysm and non-obstructive coronary artery disease one year prior, after presenting to the emergency department with multiple syncopal episodes, chest pain and dyspnoea on exertion. Chest X-ray showed an abnormal left cardio-mediastinal contour. Transthoracic echocardiography revealed a bicuspid pulmonary valve with mild stenosis and regurgitation, PAP (pulmonary artery pressure) - 20 mmHG. CTPA at the original presentation showed maximal main PA diameter of 60 mm with no aneurysmal involvement of the right and left pulmonary branches. She had no features suggestive of connective tissue disorders. CTPA on this admission however, showed an alarming increase in the maximal main PA diameter of 64.7 mm with a new finding of left PA enlargement measuring 33 mm. There was no dissection in the the PA wall. She underwent plication of the pulmonary artery extending into the left PA to a final size of < 30 mm by direct measurement. She was discharged on the 7th postoperative day without any complications. Follow-up CTPA at 6 months showed no further enlargement of the main PA.
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