Ann Thorac Surg 2009;87:e29. doi:10.1016/j.athoracsur.2008.12.035
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Pulmonary Artery Aneurysm and Hypoplastic Aortic Arch
Jian Yang, MD, PhD*,
Xiuling Yang, MD*,
Dinghua Yi, MD, PhD*
Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China
* Address correspondence to Dr Yi, Department of Cardiovascular Surgery, Xijing Hospital, 15 Chang Le West Rd, Xincheng District, Xi'an, 710032, People's Republic of China (Email: yidh{at}fmmu.edu.cn).
A 17-year-old girl with a 3-year history of severe pulmonary hypertension presented with progressive shortness of breath, fatigue, and weakness. A systolic murmur of degree II could be found in her second left anterior intercostal space. Echocardiography showed a big perimembranous ventricular septal defect of 18 mm in diameter and interrupted aortic arch with median left-to-right shunt. A multi-sliced computed tomographic scan found a pulmonary artery aneurysm of 9.1 cm and hypoplastic aortic arch (Fig 1, panel A). Angiography confirmed the findings of a computed tomographic scan (Fig 1, panel B) and cardiac catheterization showed severe pulmonary hypertension of 142/88 (106) mm Hg, with concomitant blood pressure of 195/100 (133) mm Hg in the right upper limb. Pulmonary arterial resistance was calculated as 12 Woods and the patient was considered still operable because there was a left-to-right shunt at catheterization, and her pulse oxygen saturation was 95%. She was referred to open surgery, during which the ventricular septal defect was closed and the aortic arch was reconstructed with a 10-mm polytetrafluoroethylene graft in an end-to-side manner under cardiopulmonary bypass and cardiac arrest. After a 5-day stay in the intensive care unit and a slow recovery, she was discharged 20 days after the operation. At her 3-months follow-up, a two-dimensional computed tomographic scan showed a well-reconstructed aortic arch and decreased pulmonary artery aneurysm (Fig 1; panels C and D). Echocardiography showed no residual arch gradient or ventricular septal defect, and her pulmonary artery pressure had fallen to 84/47 (62) mm Hg.
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* Drs Jian Yiang and Xiuling Yang contributed equally to this paper. 
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