Pulmonary artery aneurysm is a rare disease with
common coexisting conditions. It can be secondary
to other pathologies such as pulmonary valve
stenosis, congenital cardiac anomalies associated with
pulmonary hypertension, Behçet's disease, trauma
and infections.[
1,
2] Pulmonary stenosis may cause excess volume or pressure load resulting in aneurysm
formation.[
3]
Although conservative management of large
aneurysms has been reported,[4] documentation of
rupture and dissection would make this strategy
inadvisable for patients who would otherwise be
considered suitable for surgery. Surgery should
be considered in patients with dilatation of the
pulmonary trunk and pulmonary arteries ≥5 cm, as
in our case.
Valve reconstruction is the goal of all the surgical
interventions, since restoration of anatomy and
physiology employs the native tissue which allows
for growth and potentially results in better long-term
outcome. In case of repair failure or inconvenience,
valve replacement would become inevitable.[5] In our
case, ideal body weight of the patient, pulmonary
artery aneurysm as a coexisting anomaly and no
requirement for growth were particularly critical issues
for the choice of valve replacement.
In patients with significant pulmonary valve stenosis
and or insufficiency, reconstruction of the RVOT
is performed in cases with congenital heart disease,
when there is discontinuity between the right ventricle
and the pulmonary branch arteries. The patients
with significant pulmonary valve annulus hypoplasia
have been previously treated using transannular patch
or valve conduit insertion. The transannular patch
immediately relieves the right ventricular hypertension
and enhances right ventricular growth proportionally
with patient growth which is particularly important
for the young patients. We enlarged the RVOT by
myectomy and closed the infundibular incision using
a pericardial patch facilitating the dilatation of the
RVOT.
The mid-term results of porcine bioprosthetic
valves in the RVOT reconstruction were reported
as excellent in the literature.[6] The main benefit of
using bioprosthetic valve is avoidance of extensive
dissection, easiness of implantation and good
hemodynamic characteristics.[6] Mechanical valves
have been used for pulmonary valve replacement in a
limited number of centers.[7] Most centers recommend
relatively large doses of warfarin and several reports
of thromboses have been documented.[8,9] In this
case, we preferred a stentless bioprosthetic valve
to obtain a larger effective orifice area and prevent
complications of warfarin and re-intervention of
RVOT.
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