Outcome of Surgical Repair of Pulmonary Artery Aneurysms: A Single-Center Experience With 38 Patients

Reconstruction of a Giant Main Pulmonary Artery Aneurysm Using a Porcine Root in an Adult Patient

Pulmonary artery aneurysm (PAA) is a rare disorder with a difficult diagnosis and debated management in literature due to the limited number of cases. Even if the definitive treatment of PAA is surgery, consistent guidelines still need to be developed to help surgeons determine when intervention is appropriate. We report a case of a 77-year-old female diagnosed with central PAA measuring 61 mm at contrast-enhanced computerized tomography scan which was treated surgically. The patient underwent a successful elective complete pulmonary root replacement with a Medtronic Freestyle (Medtronic Inc, Minneapolis, MN) porcine root. Postprocedural recovery and follow-up at 12 months were uneventful.

A gray zone in the literature: indications, options, and outcomes for surgical repair of pulmonary artery aneurysms

Pulmonary artery aneurysms are rare. They are characterised by an aneurysmatic dilatation of the pulmonary vascular bed, including the main pulmonary artery or the accompanying pulmonary artery branches. Increases in pulmonary flow and pulmonary artery pressure increase the risk of rupture: when these conditions are detected, surgical intervention is necessary.This study is a retrospective analysis of 33 patients treated in our paediatric cardiac surgery clinic from 2012 to 2020. Aneurysms and pseudoaneurysms in patients who were patched for right ventricular outflow tract reconstruction and corrected with a conduit were excluded from the study. Seventeen (51.5%) of the patients included in the study were female and 16 (48.5%) were male. The patients were aged between 23 and 61 years (mean 30.66 ± 12.72 years). Graft interpositions were performed in 10 patients (30.3%) and pulmonary artery plications were performed in 23 patients (69.7%) to repair aneurysms. There was no significant difference in mortality between the two groups (p > 0.05).Pulmonary artery aneurysm interventions are safe, life-saving treatments that prevent fatal complications such as ruptures, but at present there is no clear guidance regarding surgical timing or treatment strategies. Pulmonary artery interventions should be performed in symptomatic patients with dilations ≥5 cm or asymptomatic patients with dilations ≥8 cm; pulmonary artery pressure, right ventricular systolic pressure, and pulmonary artery aneurysm diameter must be considered when planning surgeries, their timing, and making decisions regarding indications. Experienced surgical teams can achieve satisfactory results using one of the following surgical techniques: reduction pulmonary arterioplasty, plication, or graft replacement.

Overlapping-plasty technique for pulmonary artery aneurysm

Massive pulmonary artery aneurysms, while extremely rare, might require surgical intervention. Most previous cases have been repaired either by pulmonary artery plication or synthetic graft replacement. We report a case of massive pulmonary artery aneurysm that was successfully repaired using an 'overlapping-plasty' technique with the help of 3D image simulation. This specially designed procedure might be useful as a surgical option for pulmonary artery aneurysms.

A case of a giant pulmonary artery aneurysm due to an atrial septal defect with left main coronary artery occlusion

Cases of coronary artery occlusion due to the exclusion of pulmonary artery aneurysm are extremely rare, and there are few reports of surgical treatment. A 60-year-old woman with pulmonary hypertension due to an atrial septal defect and obstruction of the left main coronary trunk due to the exclusion of a giant pulmonary artery aneurysm underwent surgery. The surgery included atrial septal defect closure, tricuspid annulus plasty, pulmonary artery aneurysmorrhaphy, and coronary artery bypass grafting. One and a half years after the surgery, no re-expansion of the pulmonary artery was observed, and the symptoms of heart failure had improved. There are no reports of improvement in pulmonary valve regurgitation by aneurysmorrhaphy in pulmonary artery aneurysm. Surgery for pulmonary artery aneurysm with the exclusion of other organs was effective, and aneurysmorrhaphy for pulmonary artery aneurysm was acceptable.

Is it time for a paradigm shift: Should double-lung transplant be considered the treatment of choice for idiopathic pulmonary arterial hypertension and giant pulmonary aneurysm?

Idiopathic pulmonary arterial hypertension is a rare condition, frequently complicated by pulmonary arteries' aneurysm. Aggressive medical therapy is often unsatisfactory and lung transplantation remains the only option. We report a unique case of severe idiopathic pulmonary arterial hypertension complicated by a giant pulmonary aneurism, massive pulmonary valve regurgitation, and right ventricle dysfunction. The patient was, as our first choice, listed for heart-lung transplantation and remained in emergency list for more than 7 months. Unfortunately, due to further clinical deterioration and the unavailability of a heart-lung bloc, plan B was mandatory. The patient underwent a combined procedure including: double lung transplant, pulmonary artery plasty, and sutureless pulmonary valve prosthesis with open deployment (first-in-man use in such scenario). Postoperative outcome was uneventful. Our thought is that double lung transplantation and conventional combined pulmonary artery/valve surgery should be considered as the first option avoiding excessive waiting times and potential further clinical deterioration.

A Case of Asymptomatic Pulmonary Artery Aneurysm with Review of Management Strategies

Pulmonary artery aneurysm (PAA) is defined as pulmonary artery diameter greater than 4 cm. With advances in cardiac imaging, the detection rate has increased but the natural history remains unknown. We present the case of a large, incidentally identified PAA in a patient with a history of congenital pulmonic stenosis.

Pulmonary Artery-Tracheal Fistula After Coil Implantation for Behcet's Disease

Behcet’s disease (BD) is a rare autoimmune disorder that results in diffuse full-thickness vasculitis. Pulmonary artery aneurysms (PAAs) and hemoptysis are known complications of this disease process, with high morbidity and mortality for affected patients. Although medical, endovascular, and surgical treatment strategies have all been described in the literature, there are little data to describe the long-term outcomes of these various treatment modalities and there continues to be a lack of clearly defined algorithms for the management of these patients. We report a case of PAA in the setting of BD who was treated over the course of many years with medical therapy and coil embolization but ultimately failed treatment, sustained a complication of coil erosion and migration into the trachea twice, and required surgical lobectomy for definitive management. We discuss an algorithm for the management of patients with BD who have PAAs.

Pulmonary artery aneurysm as a result of group 2 pulmonary artery hypertension in a patient with significant mitral and aortic valve disease - review and case report

Aneurysms are uncommon, but potentially life-threatening abnormalities of the pulmonary arteries. Aneurysm of the main pulmonary artery (MPA) defined as MPA diameter over 40 mm was reported in 1 : 14 000 autopsies. The most frequent location is the main pulmonary artery (89% of cases), whereas the maximum described diameter is 106–170 mm. Clinical manifestations are usually nonspecific or asymptomatic. Right heart failure symptoms, pulmonary regurgitation, trachea or bronchi compression or pulmonary emboli caused by enlarged MPA are the most commonly described clinical manifestations. Pulmonary artery aneurysm dissection is an uncommon complication but associated with a high mortality rate. Unfortunately, guidelines regulating the optimal time for the surgical intervention still have not been developed. We present the history of 76-year-old patient suffering from an aneurysm of the pulmonary artery (74 × 61 mm), as well as mitral and aortic valve disease, who was successfully operated on in our hospital.

Management of incidentally diagnosed pulmonary artery dissection in patients with pulmonary arterial hypertension

Pulmonary artery dissection is a rare entity, usually discovered post-mortem. In recent years, reported cases of living patients with a pulmonary artery dissection are growing and represent a challenging situation for clinicians.

Surgical repair of a giant pulmonary artery aneurysm that caused severe left bronchial obstruction

A 63-year-old woman on oral steroids for systemic lupus erythematosus presented with a giant pulmonary artery aneurysm severely compressing the left main bronchus and lung. Her presenting symptom was severe respiratory distress. Surgical graft replacement of the main and branch pulmonary arteries was performed, and her respiratory function improved dramatically. Bronchial obstruction was resolved immediately after the procedure.

Heart-lung transplantation for idiopathic pulmonary arterial hypertension and giant pulmonary artery aneurysm - case report

Backgound

Idiopathic pulmonary arterial hypertension (IPAH) is a rare condition that requires lung transplantation in patients’ refractory to medical therapy. Pulmonary artery aneurysm (PAA) is a documented complication of IPAH however, optimal management and timing of intervention for this rare entity is not well understood.

Case report

We report a case of a 51-year-old female who underwent heart-lung transplantation for IPAH and giant PAA. The extreme size of the PAA and underlying pathology encountered in this case precluded both lung transplantation and conventional aneurysm repair.

Conclusion

This case demonstrates that heart-lung transplantation is a good surgical option for IPAH complicated by giant sized PAA and right heart failure.

David's procedure for pulmonary artery aneurysm

Pulmonary artery aneurysm (PAA) is a rare entity with fatal complications. Its silent course contributes to large aneurysms with compression symptoms. We present a 39-year-old female idiopathic pulmonary arterial hypertension patient with a giant PAA causing severe pulmonary regurgitation (PR) and symptomatic left main coronary artery compression (LMCA). Since she had a failed LMCA stenting attempt, she underwent surgery. A valve-sparing David-like pulmonary trunk reconstruction and coronary artery bypass were performed. This case illustrates that David-like reconstruction procedure can be applied to the PAA with severe PR.

Pulmonary artery aneurysms: Preoperative, intraoperative, and postoperative findings

BACKGROUND

Pulmonary artery aneurysms (PAAs) are a rare but potentially lethal cardiovascular pathology. PAAs tend to develop in young patients with no gender discrepancy; they are most often associated with congenital heart disorders but also with systemic infections, vasculitis, pulmonary arterial hypertension, chronic pulmonary embolism, and malignancies. Dissection and rupture carry significant morbidity and mortality, thus patients require careful management, especially those with associated pulmonary hypertension. Given the rarity of this condition, physicians have yet to establish standard treatment guidelines. Most studies published to date are case reports with one or two patients; here, we describe our experience with six cases of large PAAs treated surgically at our institution.

METHODS

We identified and retrospectively analyzed clinical data for patients who underwent surgery for PAAs between 2009 and 2017.

RESULTS

The average age at surgery was 59.73 years, five patients were females, and 83.3% had baseline hypertension. Systolic murmurs were the most common clinical finding. The average aneurysmal size was 65.0 mm. We repaired the PAA with a woven Dacron graft (22-26 mm) in four patients. We performed concomitant pulmonary valve procedures on five patients: four replacements and one repair. Mean pump and cross-clamp times were 108.5 and 65 minutes. Operative and 30-day mortality was 0%. Average length of stay was 10.5 days.

CONCLUSIONS

Postoperative mortality was 0%; all patients showed improvement of symptoms after surgery. These findings confirm that PAA repair has an acceptable risk profile in select patients.

Minimally Invasive Pulmonary Artery Aneurysm Repair Through a Left Anterior Minithoracotomy-an Alternative Approach

The purpose in this case was to repair a less invasive approach than a standard sternotomy. Workup of asymptomatic patient with computerized tomography scan of chest revealed pulmonary artery aneurysm and transesophageal echocardiography demonstrated flow stagnation in aneurysm. An alternative minimally invasive approach was performed to repair the pulmonary artery aneurysm with plication through a left anterior minithoracotomy using normothermic cardiopulmonary bypass with percutaneous peripheral cannulation, instead of median sternotomy. Post-repair transesophageal echocardiography demonstrated normal flow in the pulmonary artery. The patient had an uneventful postoperative course and was seen in the outpatient clinic with excellent recovery. Minimally invasive repair of pulmonary artery aneurysm through a left anterior minithoracotomy is a feasible alternative approach. Minimally invasive repair of pulmonary artery aneurysm through a left anterior minithoracotomy is a feasible alternative approach.

Improvement of lung function and pulmonary hypertension after pulmonary aneurysm repair: case series

Pulmonary artery aneurysms (PAA) can be complicated with pulmonary arterial hypertension (PAH), causing sudden death due to PA rupture and dissection. Because treatment with PAH-targeted drugs does not always prevent PAA progression, prophylactic surgical repair of the PAA seems a promising alternative. However, although it avoids rupture and dissection of the PAs, additional benefits have not been forthcoming. We therefore present two patients with co-existing PAH and a PAA who underwent surgical repair of the aneurysm. Following the surgery, their lung function and pulmonary hypertension improved. Optimal treatment of PAA remains uncertain, however, with no clear guidelines regarding the best therapeutic approach. This case series provides physicians with reasons to repair PAA surgically in patients with PAH.