Ultraschall Med 2013; 34 - WS_SL15_06
DOI: 10.1055/s-0033-1354898

Aneurysm of the pulmonary artery and aorticopulmonary septal defect in an 80 year old woman

C Würz 1, A Schuler 1
  • 1ALB FILS Kliniken, Medizinische Klinik Helfenstein Klinik Geislingen, Germany

Introduction: Aorticopulmonary septal defect, aorticopulmonary window or partial truncus arteriosus are other designations applied to this relatively uncommon congenital anomaly. This defect results because of incomplete fusion of the distal aorticopulmonary septum during the embryonic life.

Material and methods: An 80 year old woman presented with increased dyspnea in our emergency room. There were several “cardiac problems” reported in her history since childhood. Nevertheless she did not have any cardiac examination in the past.

Results: The chest Roentgenogram showed cardiomegaly, signs of pulmonary hypertension and pleural effusions, which were proven with thoracic ultasound. The ECG presented atrial fibrillation. The echocardiography visualized an aneurysm of the pulmonary artery with a size of 62 mm. The left ventricular function was still normal. The transoesophageal access demonstrated a defect (size14 mm) between the ascending aorta and the pulmonary artery with an extended flow from the aorta to the aneurysm in Colour Doppler. In conclusion these imaging findings were conclusive for an aorticopulmonary septal defect.

Discussion: Because of leading to pulmonary hypertension, the surgical closure of an aorticopulmonary septal defect with a patch is indicated in all symptomatic infants, when diagnosis is made. This repair is advised at 3 to 6 month. The prognosis reaching the adulthood without surgery is poor. In contrast to our described congenital defect, cases of persistent ductus arteriosus are reported with the survival to age 72 and older. This fact and the extensive aneurysm of the pulmonary artery turn our case in to an extraordinary one.

Conclusion: An unknown congenital anomaly is a very rare reason for heart failure in senior patients. Visualizing an aneurysm of the pulmonary artery in the echocardiography should lead to a transesophageal echocardiography in order to exclude or prove such an anomaly.