Surgical Repair of Giant Dissecting Pulmonary Artery Aneurysm Associated with Atrial Septal Defect and Pulmonary Arterial Hypertension: A Case Report
DOI:
https://doi.org/10.59958/hsf.6835Keywords:
pulmonary artery aneurysm, atrial septal defect, pulmonary arterial hypertension, dissectionAbstract
Pulmonary artery aneurysm (PAA) and pulmonary artery dissection (PAD) are rare and potentially fatal conditions that may lead to pulmonary artery (PA) rupture and cardiac tamponade. PAA is often associated with other cardiac and congenital heart diseases, such as atrial septal defect (ASD). We report a case of a patient with ASD and a giant dissecting PAA who underwent surgical repair to prevent potentially fatal outcome and discuss the probable etiologies of this case. We present a rare case of a 50-year-old woman with a secundum ASD and severe pulmonary arterial hypertension (PAH) who developed a giant PAA of 114 mm with dissection. The PAA caused extrinsic compression of the left main coronary artery (LMCA), which was misdiagnosed as coronary artery disease (CAD) at local hospital. Right heart catheterization revealed PAH of 73 mmHg and she was referred to our center for further treatment. After 4 months of lowering PAH treatment, she underwent successful surgical repair of the PAA to release the compression of LMCA, as well as mechanical valve replacement, fenestrated ASD closure and tricuspid valvuloplasty. She had an uneventful recovery and showed significant improvement in pulmonary hemodynamics and clinical symptoms at one-year follow-up. PAA with dissection is a rare complication of ASD and PAH that can potentially be fatal. Patients with large or symptomatic PAA and PAD may require early surgical intervention, particularly if they experience compression of nearby structures or are at risk of rupture. It is crucial to promptly refer and consult with specialists and ensure optimal preoperative hemodynamic management to enhance patient outcomes.
References
Duijnhouwer AL, Navarese EP, Van Dijk APJ, Loeys B, Roos-Hesselink JW, De Boer MJ. Aneurysm of the Pulmonary Artery, a Systematic Review and Critical Analysis of Current Literature. Congenital Heart Disease. 2016; 11: 102–109.
Zhang C, Huang X, Li S, Yao H, Zhang B. Pulmonary Artery Dissection: A Fatal Complication of Pulmonary Hypertension. Case Reports in Medicine. 2016; 2016: 4739803.
Egbe AC, Miranda WR, Jain CC, Anderson JH, Stephens EH, Andi K, et al. Risk of pulmonary artery dissection in adults with congenital heart disease. International Journal of Cardiology. 2023; 370: 186–190.
Kreibich M, Siepe M, Kroll J, Höhn R, Grohmann J, Beyersdorf F. Aneurysms of the pulmonary artery. Circulation. 2015; 131: 310–316.
Fernando DMG, Thilakarathne SMNK, Wickramasinghe CU. Pulmonary artery dissection-A review of 150 cases. Heart & Lung: the Journal of Critical Care. 2019; 48: 428–435.
Gupta M, Agrawal A, Iakovou A, Cohen S, Shah R, Talwar A. Pulmonary artery aneurysm: a review. Pulmonary Circulation. 2020; 10: 2045894020908780.
Savic V, Rahmanian LB, Renner T, Emmert MY, Mestres CA. Acute Pulmonary Artery Dissection With an Ongoing Extrinsic Myocardial Infarction. JACC. Case Reports. 2019; 1: 376–380.
Pan HC, Wang KY, Liang KW. Left Main Coronary Artery Stenting to Relieve Extrinsic Compression by a Giant Pulmonary Artery Aneurysm in a Patient with Idiopathic Pulmonary Artery Hypertension. Heart, Lung & Circulation. 2016; 25: e122–e125.
Adodo DK, Kloeckner M, Bergoend E, Couëtil JP. Pulmonary Artery Dissection: A Case Treated by Homograft Replacement. The Annals of Thoracic Surgery. 2017; 103: e47–e49.
Perrotta S, Lentini S. Pulmonary artery dissection. Journal of Cardiac Surgery. 2015; 30: 442–447.
Malm CJ, Ternström L, Jörgensen K, Dellgren G. Pulmonary artery dissection in a patient with undiagnosed pulmonary hypertension–A case report and review of literature. Heart & Lung: the Journal of Critical Care. 2015; 44: 453–457.
Tiwari N, Ganguly G, Garg A, Nagi GS, Hasnain S, Dikshit V. Pulmonary artery aneurysm with dissection and hemopericardium. Asian Cardiovascular & Thoracic Annals. 2013; 21: 71–73.
Zhang H, Chen X, Ao XL, Ma L. Chronic concomitant pulmonary artery and aortic dissection following patent ductus arteriosus occlusion surgery. European Heart Journal. 2023; 44: 1283.
Ku LZ, Xiong QF, Xia J, Lv H, Cheng YP, Jing Ma X. Rare Association of Right Ventricular Double Outlet With a Giant Main Pulmonary Artery Aneurysm With Dissection and Coarctation of Aorta With Dysplasia: A Multimodality Imaging Diagnosis and Therapeutic Approach. Circulation. Cardiovascular Imaging. 2022; 15: e013658.
de Biasi AR, Wang H, Medina MG, Burton E, Ogden WD. Successful beating-heart repair of pulmonary artery dissection using a composite valve-tube graft. Journal of Cardiac Surgery. 2021; 36: 2136–2139.
Togo S, Ouattara M, Sankaré I, Yéna S, Diani N, Camara AM. Conservative management of pulmonary artery dissection. Surgical Science. 2015; 6: 311.
Nuche J, Montero Cabezas JM, Alonso Charterina S, Escribano Subías P. Management of incidentally diagnosed pulmonary artery dissection in patients with pulmonary arterial hypertension. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 2019; 56: 210–212.
Liu C, Xia L, Pu Q, Liu L. A Full-Length Pulmonary Artery Dissection. American Journal of Respiratory and Critical Care Medicine. 2018; 197: 1344–1345.
Ganapathi AM, Daniels CJ. Pulmonary-Artery Aneurysm with Acute Dissection. The New England Journal of Medicine. 2022; 386: 273.
Florczyk M, Wieteska M, Kurzyna M, Gościniak P, Pepke-Żaba J, Biederman A, et al. Acute and chronic dissection of pulmonary artery: new challenges in pulmonary arterial hypertension? Pulmonary Circulation. 2018; 8: 2045893217749114.
Tomasino M, Soriano Colomè T, Sambola Ayala A, Gordon Ramírez B. Acute pulmonary artery dissection in an adult with chronic pulmonary hypertension secondary to congenital heart disease: a case report. European Heart Journal. Case Reports. 2023; 7: ytad508.
Rudziński PN, Henzel J, Dzielińska Z, Lubiszewska BM, Michałowska I, Szymański P, et al. Pulmonary artery rupture as a complication of Swan-Ganz catheter application. Diagnosis and endovascular treatment: a single centre's experience. Postepy W Kardiologii Interwencyjnej = Advances in Interventional Cardiology. 2016; 12: 135–139.
Zhu Y, Tang L, Shi H. Endovascular Repair for Pulmonary Artery and Aortic Dissection Associated With Patent Ductus Arteriosus. JACC. Cardiovascular Interventions. 2016; 9: 387–388.
Mularek-Kubzdela T, Wojnarski J, Kamiński K, Ochman M, Kasprzak JD, Stącel T, et al. Lung transplantation in patients with pulmonary arterial hypertension: The opinion of the Polish Cardiac Society Working Group on Pulmonar y Circulation. Kardiologia Polska (Polish Heart Journal). 2022; 80: 1169–1181.
McGlothlin DP, Granton J, Klepetko W, Beghetti M, Rosenzweig EB, Corris PA, et al. ISHLT consensus statement: Perioperative management of patients with pulmonary hypertension and right heart failure undergoing surgery. The Journal of Heart and Lung Transplantation: the Official Publication of the International Society for Heart Transplantation. 2022; 41: 1135–1194.
Westaby S, Evans BJ, Ormerod O. Pulmonary-artery dissection in patients with Eisenmenger's syndrome. The New England Journal of Medicine. 2007; 356: 2110–2112.
Tønder N, Køber L, Hassager C. Pulmonary artery dissection in a patient with Eisenmenger syndrome treated with heart and lung transplantation. European Journal of Echocardiography: the Journal of the Working Group on Echocardiography of the European Society of Cardiology. 2004; 5: 228–230.
Jung LY. Is pulmonary artery dissection predictable? Heart & Lung: the Journal of Critical Care. 2016; 45: 79–80.
Veldtman GR, Dearani JA, Warnes CA. Low pressure giant pulmonary artery aneurysms in the adult: natural history and management strategies. Heart (British Cardiac Society). 2003; 89: 1067–1070.
Zhang H, Weng C, Yuan D, Wang T. Pulmonary artery aneurysm and dissection caused by patent ductus arteriosus. European Heart Journal. 2022; 43: 4441.
Graham JK, Shehata B. Sudden death due to dissecting pulmonary artery aneurysm: a case report and review of the literature. The American Journal of Forensic Medicine and Pathology. 2007; 28: 342–344.
Zhao Q, Chen H, Zhang G, Chen W, Jia B, Liu F, et al. High Prevalence of Unrecognized Congenital Heart Disease in School-Age Children in Rural China: A Population-Based Echocardiographic Screening Study. Circulation. 2021; 144: 1896–1898.
Ginat DT, Sahler L. Catheter-Induced Pulmonary Artery Dissection and Contrast Extravasation During Pulmonary Angiography. Radiology Case Reports. 2009, 4: 278.
