Excerpt

An 80-year-old female patient presented to our outpatient clinic because of dyspnea on minimal exertion lasting for 6 months. Her past medical history included a secundum type atrial septal defect corrected surgically 30 years earlier and hypertension controlled with valsartan 160 mg plus hydrochlorothiazide 12.5 mg. She had been doing well since then. She had been lost to follow-up until recently, and no imaging study was performed on the patient until presentation. She was active and had an acceptable quality of life. She had a 6-month history of progressive dyspnea, fatigue, and palpitations. Her functional capacity was NYHA class III. On physical examination, she had no cyanosis or clubbing, and there was P2 loudness on auscultation. O₂ saturation on room air was 90 %. An electrocardiogram showed atrial fibrillation, right axis deviation, and right bundle branch block. The patient’s mean heart rate was 80 bpm. A chest radiograph revealed enlargement in the right heart silhouette. Hemoglobin, hematocrit, and NT-proBNP values were 13 g/dl, 40 %, and 986 pg/ml, respectively. Other laboratory test results were normal. Transthoracic echocardiography showed an aneurysm of the main pulmonary artery measuring approximately 5.3 cm and dilatation of the left and right pulmonary arteries. There was no flow across the atrial septum on color Doppler examination. Enlargement of the left atrium and the right heart chambers as well as moderate tricuspid regurgitation were detected. Pulmonary arterial systolic pressure was estimated to be 45 mmHg (Fig. 1, Video 1). …