Giant, high pressure pulmonary artery aneurysm in a grand multiparous woman

A 33-year-old woman in the ninth week of her eighth pregnancy was referred to our clinic because of dyspnoea on mild exertion. She had had seven uncomplicated pregnancies in her past medical history. Physical examination revealed a grade 3/6 systolic murmur in the pulmonary area. The electrocardiogram showed right bundle branch block and right ventricular strain pattern. Transthoracic echocardiogram revealed an aneurysm of the pulmonary artery with extremely high pulmonary artery pressure and right ventricular hypertrophy (figure 1). She was offered medical abortion. Cardiovascular magnetic resonance imaging demonstrated aneurysmatic dilatation of the main pulmonary artery with extension to the bilateral main branches (figure 2). Subsequent cardiac catheterisation confirmed aneurysmatic dilatation of the main pulmonary artery without any shunt (figure 3). After other possible causes were all sought carefully in detail, the diagnosis of idiopathic pulmonary hypertension with pulmonary artery aneurysm was made in this patient. Interestingly, she had been completely free of symptoms during her previous pregnancies. She refused surgical treatment due to the risks of the operation. She has been followed up medically with bosentan and warfarin for two months. …