Giant pulmonary artery aneurysm in a patient with vasoreactive pulmonary hypertension: a case report

The authors report a case of a 65-year old patient with pulmonary artery aneurysm associated with pulmonary arterial hypertension. Due to a positive vasoreactivity test, treatment with calcium channel blockers was started with near normalization of the right cardiac pressures. Nevertheless, after 20 months of treatment, the pulmonary artery aneurysm size remained unchanged with an associated severe pulmonary regurgitation and causing extrinsic compression of the main left coronary artery. Surgical correction was successfully performed.This is the first case report of a pulmonary artery aneurysm described to be associated with vasoreactive pulmonary hypertension in a living patient. Although medical therapy for pulmonary hypertension was started, surgical correction of the aneurysm was executed in order to prevent its future complications.Pulmonary artery aneurysm refers to dilatation of the Pulmonary Artery (PA). Although some authors have proposed a cut-off of 4 cm in diameter in the past [1], a clear definition of PA aneurysm is not available as for aortic aneurysms [2].It used to be an autopsy finding due to its asymptomatic course in the majority of the cases [3].Several etiologies have been described in the pathogenesis of PA aneurysm, namely, pulmonary hypertension (PH), congenital heart disease, Beh？et disease, infections such as the formerly prevalent syphilis, arteriovenous fistulas, connective tissue diseases, atherosclerosis and trauma [3,4]. Since the introduction of antibiotics non-infective causes of PA aneurysms have become more common [4].With the technological advances in medicine, PA aneurysms have been diagnosed in living patients by computed tomography and magnetic resonance imaging [5].The pathophysiology of the PA aneurysm is related to vessel wall stress that leads to vessel progressive dilatation or even rupture. Thus, once formed, an aneurysm tends to gradually enlarge [6].Aneurysm dissection is a potentially fatal complication in about one