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Case Report

EJCM 2019;7(2):98-100 DOI: 10.32596/ejcm.galenos.2019.00006

Pulmonary Artery Aneurysm Causing

Left Main Coronary Artery Disease
Baburhan Özbek1, Nursen Tanrıkulu2

1Van Training and Research Hospital, Clinic of Pediatric Cardiovascular Surgery, Van, Turkey
2Kolan International Hospital, Clinic of Anesthesiology, İstanbul, Turkey

Abstract

Pulmonary artery aneurysm is a rare clinical condition but pulmonary artery aneurysm causing the compression of left
may lead to serious complications such as pulmonary artery main coronary artery and presenting with chest pain. Owing
dissection, rupture and compression of left main coronary to the successful surgical correction of the aneurysm, the
artery. The relation between the pulmonary artery and the compression of the left main coronary artery was removed.
adjacent structures should be considered after the diagnosis Relief of the coronary artery from the compression might
of the aneurysm. Surgery is suggested in the patients with be enough to improve symptoms in the patients with
increased diameter of the pulmonary artery or symptoms pulmonary artery aneurysm.
caused by the compression to the neighborhood tissues. In Keywords: Aneurysm, dissection, left main coronary
this case, we are reporting a 52-year-old female patient with artery, pulmonary artery

Introduction endocarditis, infection, pulmonary hypertension,

Pulmonary artery aneurysm (PAA) is a rare clinical neoplasia, trauma, pulmonary cardiac disease, pulmonary
condition, which might be developed congenitally or artery dissection, pulmonary embolism, arteriovenous
acquired(1). Main pulmonary artery diameter over 43.4 fistula and idiopathic causes were reported in the etiology
mm in males and 40.4 mm in females or 1.5 times wider of the PAA(3).
than normal values is defined as PAA(2). Congenital PAA has no specific symptoms. PAA might cause
cardiac diseases, connective tissue diseases, vasculitis, compression on neighboring structures by getting

Address for Correspondence: Baburhan Özbek, Van Training and Research Hospital, Clinic of Pediatric Cardiovascular Surgery,
Van, Turkey
Phone: +90 505 591 60 57 e-mail: baburhanozbek@gmail.com ORCID ID: orcid.org/0000-0002-3671-2128
Received: 10.02.2019 Accepted: 22.05.2019
Cite this article as: Özbek B, Tanrıkulu N. Pulmonary Artery Aneurysm Causing Left Main Coronary Artery Disease. EJCM
2019;7(2):98-100.
DOI: 10.32596/ejcm.2019.00006
©Copyright 2019 by Heart and Health Foundation of Turkey (TÜSAV) / E Journal of Cardiovascular Medicine published by Galenos Publishing House.
 99
Case Report

wider and patients might be symptomatic due to the right and left pulmonary arterial branches and compressed
compression(4). Cough, dyspnea, hoarseness, pulmonary on LMCA.
artery fistulization to trachea, hemoptysis and chest pain After the median sternotomy and pericardiotomy
might develop according to the compressed tissue. In this expansion in pulmonary artery and its branches was
case we are presenting successful surgical treatment of noted. Standard cardiopulmonary bypass (CPB) was
PAA that referred with chest pain and dyspnea. maintained with aortic and bicaval venous cannulation.
Case Report Aneurysmatic pulmonary artery was exposed. Pulmonary
A 52-year-old patient referred to our clinic with the arteriotomy was done. Pulmonary valve had a normal
complaints of chest pain and dyspnea. The functional anatomic structure, then aneurysmatic pulmonary artery
capacity of the patient was New York Heart Association was extracted. Graft interposition of 32 mm Dacron
(NYHA) class 3 and vital findings were normal. In the chest graft for the main pulmonary artery and 28 mm Dacron
radiography, cardiothoracic ratio had minimally increased graft for pulmonary arterial branches was done with 4-0
(0.55) and pulmonary artery shadow was pronounced. prolene stitches. Atrial septal defect was repaired with
Pulmonary artery was enlarged with the diameter of 54 pericardial patch. Operation was ended after termination
mm. in the transthoracic echocardiography (TTE). Also, of the CPB. Aortic cross clamp time was 111 minutes and
there were 12 mm. secundum type atrial septal defect, total perfusion time was 136 minutes. The patient was
mild tricuspid and pulmonary valve regurgitation. Left extubated on postoperative seventh hour. There was mild
main coronary artery (LMCA) disease caused by the tricuspid valve regurgitation and low pulmonary arterial
compression of the PAA was diagnosed in the coronary hypertension in the postoperative second day control TTE.
angiography (Figure 1). Mean pulmonary artery pressure Control angiography was performed at postoperative
was 32 mmHg. Computed tomography revealed main 5th day and it was observed that the stenosis caused by
PAA with the diameter of 56 mm. That extending to the the external compression on LMCA had completely
disappeared (Figure 2). The patient was discharged from
the hospital on postoperative seventh day. Postoperative
functional capacity of the patient was observed as NYHA
class 1 in follow-up period.

Figure 1A. Left main coronary artery stenosis due to compression Figure 1B. View of the left main coronary artery after removal of
of the pulmonary artery aneurysm the compression

E Journal of Cardiovascular Medicine | Volume 7 | Issue 2 | 2019

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Case Report

Informed consent form was obtained from the patient. Ethics

Discussion Informed Consent: Informed consent form was
PAA involving main pulmonary artery together with its obtained from the patient.
branches are rare as in our case and it was reported with Peer-review: Externally and internally peer-reviewed.
rate of 11% of all PAAs(5). External compression of the
Authorship Contributions
coronary arteries might be presented as coronary arterial
disease. In this clinic condition relief of compression Surgical and Medical Practices: B.Ö., N.T.,
might be enough for the treatment rather than the coronary Concept: B.Ö., Design: B.Ö., Data Collection or
artery bypass grafting. In our case we diagnosed external Processing: B.Ö., Analysis or Interpretation: B.Ö., N.T.,
compression of the PAA to the LMCA in the detailed Literature Search: N.T., Writing: B.Ö., N.T.
examination. There is no need to coronary artery bypass Conflict of Interest:  No conflict of interest was
grafting after decompression of the PAA. declared by the authors.
Although there is no exact mechanism of the etiology, Financial Disclosure: The authors declared that this
cystic medial degeneration of the media layer of pulmonary study received no financial support.
artery or prostaglandin E receptors might play role for the
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Özbek and Tanrıkulu. LMCA Compression By Pulmonary Aneurysm