Graft Replacement and Pulmonary Valve Replacement for Pulmonary Valve Regurgitation and Pulmonary Artery Aneurysm in an Elderly Female Patient

Abstract

An 88-year old woman, who had been followed up in our center with a dilation of pulmonary artery and pulmonary valve regurgitation, was admitted with progressive exertional dyspnea and ambulant edema. Several examinations demonstrated the pulmonary artery dilated over 55 mm with pulmonary hypertension (mean pressure 39 mmHg) and significant pulmonary valve regurgitation with moderate to severe grade. No congenital heart anomaly was identified. Surgery was indicated because of progressive dilation of the pulmonary artery and worsening heart failure. We performed graft replacement of the pulmonary artery with a Y-shaped Dacron graft and pulmonary valve replacement using a bovine bioprothetic valve through a median sternotomy under cardiopulmonary bypass. Each pulmonary valve leaflet seemed to be normal, and the pulmonary valve regurgitation was caused by shallow coaptation due to dilation of the sinotubular junction. Pathological examination of the excised aneurysms revealed true aneurysmal formation with no specific inflammatory changes. Although her postoperative course was relatively complicated requiring prolonged ventilation support, she was transferred on postoperative day 56th for rehabilitation program. Her physical condition returned to well 6 months after postoperatively.