Pulmonary Trunk Aneurysm with Ascending Aortic Aneurysm, Concomitant with Bilateral Semilunar Valve Insufficiency
10.4326/jjcvs.39.122
- VernacularTitle:小児期に発見された肺動脈主幹部瘤, 上行大動脈瘤, 肺動脈弁閉鎖不全症, 大動脈弁閉鎖不全症の1手術例
- Author:
Masaaki Sugawara
;
Fumiaki Oguma
;
Hiroyuki Hirahara
;
Chizuo Kikuchi
- Publication Type:Journal Article
- Keywords:
pulmonary trunk aneurysm;
aortic aneurysm;
aneurysmorrhaphy;
aortic valve replacement;
pulmonary valvuloplasty
- From:Japanese Journal of Cardiovascular Surgery
2010;39(3):122-125
- CountryJapan
- Language:Japanese
-
Abstract:
Simultaneous pulmonary trunk and ascending aortic aneurysms are very rare, and the role of surgery in this entity is not well defined. We report a rare case of aneurysm of both the pulmonary trunk and the ascending aorta, associated with pulmonary and aortic valve insufficiency in a 17-year-old boy. Cardiac disease had been diagnosed at the age of 5, and at that time, pulmonary and aortic valve insufficiency were found by ultrasound cardiography (UCG). At regular follow-up, both cardiac valve regurgitation and the dilatation of the aneurysm gradually increased. A recent computed tomographic scan revealed that the ascending aortic aneurysm was 55 mm and the pulmonary trunk aneurysm was 60 mm. A UCG also showed severe aortic valve regurgitation and moderate pulmonary valve regurgitation with no pulmonary hypertension. Surgical repair was performed successfully. The aortic valve was replaced with a mechanical valve. The dilated ascending aortic aneurysm was excised and replaced with a Dacron graft. The pulmonary trunk aneurysm was incised longitudinally. The pulmonary valve was tricuspid, and no organic leaflets change was observed. Pulmonary valvuloplasty by commissure plication of the prolapsed cusps was performed. A large portion of the anterior pulmonary aneurysm wall was excised and plicated to reduce the radius diameter. The pathology of the aneurysm wall showed infiltration of inflammatory cells in the tunica media, fragmentation and decrease of elastic fiber, loss of muscular tissue, and increase in collagen fibers. No cystic medial necrosis was observed in the pathologic specimen. The postoperative course was uneventful, and there were no adverse events or complications at 2 years follow-up. The following image study revealed the normal size of the great vessels.
