Yaméogo N V, Ndiaye M B, Diao M, Cabral-Ciss E C, Sarr M, Ba S A
Travail de la clinique cardiologique du CHU Aristide Le Dantec, BP 26053, Parcelles Assainies, Dakar, Sénégal.
Ann Cardiol Angeiol (Paris). 2013 Feb;62(1):60-3. doi: 10.1016/j.ancard.2010.12.020. Epub 2011 Jan 19.
Pulmonary arteries aneurysms are rare and the rarely described bilateral aneurysms. A 45-year-old patient carrier of mitral stenosis was admitted for dyspnoea class III of the NYHA, chest pain and a not infectious cough. The clinical examination found semiology of mitral stenosis, tricuspid incapacity and pulmonary arterial hypertension. The electrocardiogram showed atrial fibrillation and right ventricle hypertrophy. Chest X-ray found a cardiomegaly, an aspect of double outline of the inferior right bow, a prominent aspect of the left average bow reminding an aneurysm of the left pulmonary artery. The echocardiography Doppler found a pure tight mitral stenosis (mitral surface=0.6 cm(2)), a dilation of the trunk of the pulmonary artery (diameter=74 mm) and of its branches (diameter of the right pulmonary artery=28 mm, diameter of the left pulmonary artery=36 mm) seat of a spontaneous contrast. The left atrium and right cardiac cavities were also dilated. There was an important tricuspid incapacity with a major pulmonary hypertension (systolic pulmonary arterial=109 mmHg). The thoracic angioscan showed a pseudoaneurysm of the trunk of pulmonary artery and its branches to their distal parts. Under diuretic, anticoagulating and analgesic treatment the clinical signs improved however the spontaneous contrast persisted. The patient was rejected by the surgery for exceeded clinical board. She is at present followed in our service for 5 months.
肺动脉瘤罕见，双侧肺动脉瘤更是鲜有报道。一名45岁二尖瓣狭窄患者因纽约心脏病协会（NYHA）III级呼吸困难、胸痛及非感染性咳嗽入院。临床检查发现二尖瓣狭窄、三尖瓣功能不全及肺动脉高压的体征。心电图显示心房颤动及右心室肥厚。胸部X线检查发现心脏扩大、右下弓双重轮廓影、左中弓突出，提示左肺动脉瘤。超声心动图多普勒检查发现单纯严重二尖瓣狭窄（二尖瓣口面积=0.6平方厘米）、肺动脉主干扩张（直径=74毫米）及其分支扩张（右肺动脉直径=28毫米，左肺动脉直径=36毫米），可见自发显影。左心房及右心腔也有扩张。存在严重三尖瓣功能不全及重度肺动脉高压（肺动脉收缩压=109毫米汞柱）。胸部血管造影显示肺动脉主干及其分支至远端部分有假性动脉瘤。在利尿、抗凝及止痛治疗下，临床症状有所改善，但自发显影仍持续存在。该患者因临床情况复杂被手术拒绝。目前在我们科室随访5个月。
