Giant Pulmonary Artery Aneurysm Associated to Severe Mitral Stenosis: Review and Case Report

I. Tlohi *

Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.

B. Nassour

Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.

F. Essadqi

Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.

A. Drighil

Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.

R. Habbal

Department of Cardiology, CHU Ibn Rochd, Casablanca, Morocco.

*Author to whom correspondence should be addressed.


Pulmonary aneurysms are rare abnormalities of the pulmonary vessels that are often associated with pulmonary hypertension. However, the occurrence and treatment of this pathology are still unclear. A 33-year-old patient with a medical history of transcutaneous mitral commissurotomy was admitted with NYHA class III dyspnea and lower extremity edema. The clinical examination found the semiology of mitral stenosis and signs of both right and left heart failure. The electrocardiogram showed complete atrial fibrillation and right ventricle hypertrophy. Chest X-ray revealed cardiac hypertrophy and a prominent aspect of the left median arch reminiscent of a left pulmonary aneurysm. Doppler echocardiography found pure severe mitral stenosis (mitral valve area = 0.8 cm2), dilation of the pulmonary trunk (diameter = 74 mm), and its branches. The right heart chamber was also dilated, with significant tricuspid regurgitation and severe pulmonary hypertension (systolic pulmonary artery = 95 mmHg). The thoracic angioscan angiography revealed aneurysmal dilation of the trunk of the pulmonary artery and its branches without dilation of their distal parts (diameter of the pulmonary artery = 76 mm; Right pulmonary artery diameter = 51 mm, left pulmonary artery diameter = 40 mm). showed aneurysmal expansion of the pulmonary trunk and its branches without expansion of the distal portion (pulmonary artery diameter = 76 mm, right pulmonary artery diameter = 51 mm, left pulmonary artery diameter = 40 mm). Clinical symptoms improved with diuretic, anticoagulant, and analgesic treatment, and the patient was subsequently referred to cardiovascular surgery for mechanical mitral valve replacement and plastic surgery of the pulmonary artery. Pulmonary aneurysms are uncommon pathology that can be potentially life-threatening. Its clinical manifestations are usually nonspecific or asymptomatic and the appropriate treatment is a challenge, as there are no clear guidelines on the recommended treatment.

Keywords: Pulmonary artery aneurysm, mitral stenosis, pulmonary hypertension, case report

How to Cite

Tlohi , I., Nassour , B., Essadqi , F., Drighil , A., & Habbal , R. (2023). Giant Pulmonary Artery Aneurysm Associated to Severe Mitral Stenosis: Review and Case Report. Asian Journal of Cardiology Research, 6(1), 142–151. Retrieved from


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Gruber PJ, Askin FB, Heitmiller RF. Pulmonary artery aneurysm in a pregnant woman. Ann Thorac Surg. 2001;71: 1023–5.

Duijnhouwer AL, Navarese EP, Van Dijk APJ, et al. Aneurysm of the pulmonary artery, a systematic review and critical analysis of current literature. Congenit Heart Dis. 2016;11:102-109.

Gallego P, Rodríguez-Puras MJ, Serrano Gotarredona P, et al. Prevalence and prognostic significance of pulmonary artery aneurysms in adults with congenital heart disease. Int J Cardiol. 2018;270:120-125.

Park HS, Chamarthy MR, Lamus D, et al. Pulmonary artery aneurysms: diagnosis and endovascular therapy. Cardiovasc Diagn Ther. 2018;8:350-361.

Marzec K, Jaworska-Wilczyńska M, Grobelny K, Kołsut P, Michałowska I, Stokłosa P, Hryniewiecki T. 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. Kardiochir Torakochirurgia Pol. 2020;17(3):143-148.

Sheikhzadeh S, De Backer J, Gorgan NR, et al. The main pulmonary artery in adults: a controlled multicenter study with assessment of echocardiographic reference values, and the frequency of dilatation and aneurysm in Marfan syndrome. Orphanet J Rare Dis. 2014;9:203.

Gupta M, Agrawal A, Iakovou A, Cohen S, Shah R, Talwar A. Pulmonary artery aneurysm: a review. Pulm Circ. 2020; 10(1):2045894020908780.

Malviya A, Jha PK, Kalita JP, Saikia MK, Mishra A. Idiopathic dilatation of pulmonary artery: A review. Indian Heart J. 2017;69(1):119-124.

Nguyen ET, Silva CI, Seely JM, Chong S, Lee KS, Müller NL. Pulmonary artery aneurysms and pseudoaneurysms in adults: findings at CT and radiography. Am J Roentgenol. 2007;188:W126–W134.

Ugolini P., Mousseaux E., Sadou Y. Idiopathic dilatation of the pulmonary artery: report of four cases. Magn Reson Imaging. 1999;17(July (6)):933–937.

Kreibich M, Siepe M, Kroll J, et al. Aneurysms of the pulmonary artery. Circulation. 2015;131: 310-316.

Reisenauer JS, Said SM, Schaff HV, et al. The outcome of surgical repair of pulmonary artery aneurysms: a single-center experience with 38 patients. Ann Thorac Surg. 2017;104:1605-1610.

Kuwaki K, Morishita K, Sato H, et al. Surgical repair of the pulmonary trunk aneurysm. Eur J Cardiothoracic Surg. 2000;18:535-539.

DeLima LG, Wynands JE, Bourke ME, Walley VM. Catherter-induced pulmonary artery false aneurysm and rapture: a case report and review. J Cardiothorac Vasc Anesth. 1994;8:70-75.

Bartter T, Irwin RS, Nash G. Aneurysm of the pulmonary arteries. Chest. 1988;94:1065–75

Kodikara S, Sivasubramanium M. Bilateral pulmonary artery aneurysms. Leg Med. 2009;(Suppl. 11):S496–7.

Butto F, Lucas RV, EdwardsJE. Pulmonary arterial aneurysm: a pathologic study of five cases. Chest. 1987;91:237–41.

Decuypere V, Delcroix M, Budts W. Left main coronary artery and right pulmonary vein compression by a large pulmonary artery aneurysm. Heart. 2004;90:e21–121

Arom KV, Richardson JD, Grover FL, Feris G, Trinkle JK. Pulmonary artery aneurysm. Am Surg. 1978;44:688–92.

Mastroroberto P, Chello M, Zofrea S, Del Negro G, De Francesca F, Maltese G. Pulmonary artery aneurysm [Letter]. Ann Thorac Surg. 1997;64:585–6.

Akagi S, Nakamura K, Sarashina T, et al. Progression of pulmonary artery dilatation in patients with pulmonary hypertension coexisting with a pulmonary artery aneurysm. J Cardiol. 2018; 71: 517-522.

Yokoyama U, Ishiwata R, Jin MH, et al. Inhibition of EP4 signaling attenuates aortic aneurysm formation. PLoS One. 2012;7:e36724.

Dilmé JF, Solà-Villà D, Bellmunt S, et al. Active smoking increases microsomal pgesynthase-1/pge-receptor-4 axis in human abdominal aortic aneurysms. Mediators Inflamm. 2014;2014:316150.

Mamun A, Yokoyama U, Saito J, et al. A selective antagonist of prostaglandin E receptor subtype 4 attenuates abdominal aortic aneurysm. Physiol Rep. 2018;6: e13878.