Case report
Giant high-pressure pulmonary artery aneurysm in an elderly patient with chronic obstructive pulmonary disease
Aneurisma gigante da artéria pulmonar de altas pressões em idoso com doença obstrutiva pulmonar crónica
Lido
8309
Vezesque se leu este artigo
1926
Total PDF
6383
Total HTML
Compartilhar estatísticas
array:25 [ "pii" => "S0870255116000172" "issn" => "08702551" "doi" => "10.1016/j.repc.2015.06.014" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "774" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2016;35:183.e1-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3722 "formatos" => array:3 [ "EPUB" => 191 "HTML" => 2950 "PDF" => 581 ] ] "Traduccion" => array:1 [ "en" => array:20 [ "pii" => "S2174204916000556" "issn" => "21742049" "doi" => "10.1016/j.repce.2015.06.010" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "774" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2016;35:183.e1-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3256 "formatos" => array:3 [ "EPUB" => 193 "HTML" => 2633 "PDF" => 430 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Giant high-pressure pulmonary artery aneurysm in an elderly patient with chronic obstructive pulmonary disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "183.e1" "paginaFinal" => "183.e6" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Aneurisma gigante da artéria pulmonar de altas pressões em idoso com doença obstrutiva pulmonar crónica" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 649 "Ancho" => 1500 "Tamanyo" => 117503 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Thoracic computed tomography scan, February 2011, revealing pronounced dilatation of the pulmonary trunk, with a maximum diameter of 72 mm, and enlargement of the main pulmonary arteries, 40 mm in diameter on the right and 33 mm in diameter on the left.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sandra A. Morais, Hugo M. Oliveira, José R. de Almeida, Eduardo Eiras, Ana Catarina Silva, Cristina Gavina" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Sandra A." "apellidos" => "Morais" ] 1 => array:2 [ "nombre" => "Hugo M." "apellidos" => "Oliveira" ] 2 => array:2 [ "nombre" => "José R." "apellidos" => "de Almeida" ] 3 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Eiras" ] 4 => array:2 [ "nombre" => "Ana Catarina" "apellidos" => "Silva" ] 5 => array:2 [ "nombre" => "Cristina" "apellidos" => "Gavina" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255116000172" "doi" => "10.1016/j.repc.2015.06.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000172?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000556?idApp=UINPBA00004E" "url" => "/21742049/0000003500000003/v1_201603180035/S2174204916000556/v1_201603180035/en/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S0870255115003418" "issn" => "08702551" "doi" => "10.1016/j.repc.2015.09.015" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "753" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2016;35:185.e1-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 10305 "formatos" => array:3 [ "EPUB" => 206 "HTML" => 9224 "PDF" => 875 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso Clínico</span>" "titulo" => "Miocárdio não compactado isolado evoluindo para insuficiência cardíaca refratária" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "185.e1" "paginaFinal" => "185.e4" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Isolated left ventricular noncompaction causing refractory heart failure" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 628 "Ancho" => 1800 "Tamanyo" => 185383 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Imagens de ecocardiograma bidimensional (A), ressonância magnética (B) evidenciando miocárdio não compactado isolado em ventrículo esquerdo, além de ventrículos direito e esquerdo dilatados. Imagens em eixo longo quatro câmaras, em diástole. Relação de massa não compactada sobre massa compactada do ventrículo esquerdo de 5,5. Peça anatômica macroscópica de coração nativo da paciente em eixo quatro câmaras (C).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael Alexandre Meneguz‐Moreno, Felipe Rodrigues da Costa Teixeira, João Manoel Rossi Neto, Marco Aurélio Finger, Carolina Casadei, Maria Teresa Castillo, Antonio Flávio Sanchez de Almeida" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Rafael Alexandre" "apellidos" => "Meneguz‐Moreno" ] 1 => array:2 [ "nombre" => "Felipe" "apellidos" => "Rodrigues da Costa Teixeira" ] 2 => array:2 [ "nombre" => "João Manoel" "apellidos" => "Rossi Neto" ] 3 => array:2 [ "nombre" => "Marco Aurélio" "apellidos" => "Finger" ] 4 => array:2 [ "nombre" => "Carolina" "apellidos" => "Casadei" ] 5 => array:2 [ "nombre" => "Maria Teresa" "apellidos" => "Castillo" ] 6 => array:2 [ "nombre" => "Antonio Flávio" "apellidos" => "Sanchez de Almeida" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217420491600043X" "doi" => "10.1016/j.repce.2015.09.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491600043X?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255115003418?idApp=UINPBA00004E" "url" => "/08702551/0000003500000003/v1_201603080050/S0870255115003418/v1_201603080050/pt/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S087025511500342X" "issn" => "08702551" "doi" => "10.1016/j.repc.2015.11.004" "estado" => "S300" "fechaPublicacion" => "2016-03-01" "aid" => "754" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2016;35:181.e1-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4030 "formatos" => array:3 [ "EPUB" => 203 "HTML" => 3154 "PDF" => 673 ] ] "pt" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso Clínico</span>" "titulo" => "Defeito do septo auriculoventricular num doente adulto. Há «fendas» e fendas" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => array:2 [ 0 => "pt" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "181.e1" "paginaFinal" => "181.e4" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Atrioventricular septal defect in an adult patient: There are ‘clefts’ and clefts" ] ] "contieneResumen" => array:2 [ "pt" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1985 "Ancho" => 2917 "Tamanyo" => 577136 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A,B – 2<span class="elsevierStyleHsp" style=""></span>D janela transgástrica. Em diástole (A), observa‐se o aspeto trifoliado do componente esquerdo da válvula AV e a «fenda» (*). Em sístole (B), evidencia‐se a regurgitação mitral com ponto de partida na «fenda».</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Fig. 1<span class="elsevierStyleHsp" style=""></span>C,D – 3<span class="elsevierStyleHsp" style=""></span>D <span class="elsevierStyleItalic">zoom</span> em tempo real <span class="elsevierStyleItalic">cropped images</span>. Em diástole, por vista auricular (C) e ventricular (D), a morfologia dos três folhetos da válvula AV esquerda aparece bem detalhada e a orientação septal (ventrículo direito) da «fenda» bem definida. A presença de cordas anormais ligando os bordos da «fenda» ao septo interventricular é bem observada por vista ventricular (seta).</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Aprecie‐se o formato elíptico do anel e a reduzida dimensão do folheto mural, outras particularidades de uma válvula esquerda AV. 1 – folheto ântero‐superior, 2 – folheto póstero‐inferior, 3 – folheto mural. AOV – válvula aórtica; LVOT – trato de saída do ventrículo esquerdo, TV – válvula tricúspide.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nuno Moreno, Jorge Almeida, Mário Jorge Amorim" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Nuno" "apellidos" => "Moreno" ] 1 => array:2 [ "nombre" => "Jorge" "apellidos" => "Almeida" ] 2 => array:2 [ "nombre" => "Mário Jorge" "apellidos" => "Amorim" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204916000428" "doi" => "10.1016/j.repce.2015.11.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916000428?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511500342X?idApp=UINPBA00004E" "url" => "/08702551/0000003500000003/v1_201603080050/S087025511500342X/v1_201603080050/pt/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Giant high-pressure pulmonary artery aneurysm in an elderly patient with chronic obstructive pulmonary disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "183.e1" "paginaFinal" => "183.e6" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sandra A. Morais, Hugo M. Oliveira, José R. de Almeida, Eduardo Eiras, Ana Catarina Silva, Cristina Gavina" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Sandra A." "apellidos" => "Morais" "email" => array:1 [ 0 => "sandramorais13@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Hugo M." "apellidos" => "Oliveira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "José R." "apellidos" => "de Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Eduardo" "apellidos" => "Eiras" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Ana Catarina" "apellidos" => "Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Cristina" "apellidos" => "Gavina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Medicina Interna, ULSM – Hospital Pedro Hispano, Matosinhos, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Radiologia, ULSM – Hospital Pedro Hispano, Matosinhos, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Serviço de Cardiologia, ULSM – Hospital Pedro Hispano, Matosinhos, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Aneurisma gigante da artéria pulmonar de altas pressões em idoso com doença obstrutiva pulmonar crónica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1448 "Ancho" => 3000 "Tamanyo" => 788332 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Electrocardiogram, February 2012, showing atrial fibrillation with a ventricular rhythm of 63/min, and no significant ST-T abnormalities.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pulmonary artery aneurysm (PAA) is a rare condition appearing in 1/14<span class="elsevierStyleHsp" style=""></span>000 of autopsies.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> However, there are no prospective studies focusing on PAA, so its precise incidence is unknown.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Many patients are completely asymptomatic and are diagnosed incidentally in imaging studies.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> A high index of suspicion is thus required for an accurate diagnosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The treatment of high-pressure PAA remains controversial but most case reports support a trend for surgical intervention due to the high risk of complications.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of a 74-year-old Caucasian male followed in our hospital for the past two decades. The patient had a history of chronic obstructive pulmonary disease (COPD), Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging system grade 3, high blood pressure, chronic atrial fibrillation (CAF), chronic right heart failure (HF) classified as New York Heart Association (NYHA) functional class II, and a 60 pack-year history of cigarette smoking.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Reviewing the patient's medical record we found a chest radiograph from 1992 (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>, left), on which mediastinal enlargement was already present.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">During the first decade of follow-up the patient remained stable under standard medical treatment for COPD and HF, and anticoagulation for CAF.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In 2000 the patient had a gastrointestinal hemorrhage forcing the suspension of anticoagulation. Pharmacological rate control with digoxin was started for treatment of CAF.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In February 2011 a routine transthoracic echocardiogram revealed moderate to severe dilatation of both atria and mild dilatation of both ventricles with normal thickness of the ventricular walls. There was no significant morphological alteration in valve structures. Moderate mitral regurgitation, mild aortic and pulmonary regurgitation, and mild to moderate tricuspid regurgitation were observed. Pulmonary artery systolic pressure (PASP) was 60 mmHg. Biventricular systolic function was preserved.</p><p id="par0045" class="elsevierStylePara elsevierViewall">On the basis of the echocardiographic findings, pulmonary hypertension due to lung disease (GOLD grade 3) was diagnosed.</p><p id="par0050" class="elsevierStylePara elsevierViewall">A routine thoracic computed tomography (CT) scan (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>) was also performed in February 2011 and revealed pronounced dilatation of the pulmonary trunk, with a maximum diameter of 72 mm, and dilatation of the main pulmonary arteries, 40 mm in diameter on the right and 33 mm in diameter on the left. There was no evidence of thrombus in the central pulmonary arteries.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The imaging exams led to a diagnosis of a giant pulmonary artery aneurysm (PAA). Closer examination of the recent chest radiographs (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>, right) confirmed the persistence of mediastinal enlargement, without significant increase, which, in comparison with the oldest chest radiograph, showed that the evolution of the PAA had been stable for the previous 20 years.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Despite the patient's stable evolution under medical treatment for the last 10 years, he was admitted to our hospital in March 2012 with severe right HF.</p><p id="par0065" class="elsevierStylePara elsevierViewall">On admission, physical examination revealed blood pressure of 112/63 mmHg, mild peripheral cyanosis, and increased expiratory time, jugular venous distention, and crackles in both lung bases on pulmonary auscultation; cardiac auscultation revealed arrhythmia with a mean ventricular rate of 70 bpm, and severe lower limb edema was observed.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Laboratory tests performed in the emergency department showed leukocyte count of 4100/μl, 59.7% neutrophils, 12.2 g/dl hemoglobin, and C-reactive protein 5.6 mg/l. On biochemical analysis, electrolytes, renal and liver function, cardiac enzymes and coagulation were all within normal limits, but serum brain natriuretic peptide (BNP) level was elevated (577.4 pg/ml).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Electrocardiography showed atrial fibrillation with a ventricular rhythm of 63/min, and no significant ST-T abnormalities (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>). The chest radiograph (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>) showed an increased cardiothoracic index, mainly due to enlargement of the right atrium and pulmonary artery.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Thoracic CT angiography revealed a PAA 72 mm in diameter but no signs of thromboembolism or thrombosis in the main pulmonary arteries and branches (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The transthoracic echocardiogram showed a PAA (not quantified because of a poor acoustic window), mild tricuspid regurgitation and PASP of 52 mmHg. The right atrial chamber was dilated and right ventricular systolic function was preserved.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The patient was admitted to the medical ward with a diagnosis of HF and was started on high-dose diuretics, with significant clinical improvement.</p><p id="par0095" class="elsevierStylePara elsevierViewall">A history of major thoracic trauma or significant clinical infection was ruled out, and antinuclear autoantibodies, serology for HIV1 and 2, and the Venereal Disease Research Laboratory and <span class="elsevierStyleItalic">Treponema pallidum</span> hemagglutination tests for syphilis were negative.</p><p id="par0100" class="elsevierStylePara elsevierViewall">After optimization of medical therapy the patient underwent right cardiac catheterization, which revealed mean pulmonary arterial pressure of 26 mmHg, right atrial pressure of 8 mmHg, pulmonary capillary wedge pressure of 12 mmHg, pulmonary vascular resistance of 3.8 Wood units and cardiac index of 2.0 l/min/m<span class="elsevierStyleSup">2</span>, which is compatible with mild precapillary pulmonary hypertension.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The diagnosis was of a giant PAA with precapillary pulmonary hypertension, possibly related to COPD (GOLD grade 3). Since there is no specific evidence-based treatment for this condition, the patient was discharged on standard HF medication, with the indication for clinical surveillance and specific treatment for COPD. At two-year follow-up he was in a stable condition and the control thoracic CT scan showed no increase in the size of the PAA.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">In the literature, several etiologies have been described in the pathogenesis of PAA, including congenital cardiac malformations with intracardiac shunt, vascular abnormalities such as arteritis (e.g., Takayasu disease) and primary pulmonary hypertension, vasculitis (e.g., Behçet's disease), connective tissue disorders (such as Marfan, Ehlers-Danlos and Hughes-Stovin syndromes and systemic lupus erythematosus), tuberous sclerosis, atherosclerosis, hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease), vascular trauma, tuberculosis, syphilis, and bacterial, fungal or other infections.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Since the introduction of antibiotics, non-infectious causes of PAA have become more common,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> with recent studies revealing an association in more than 50% of cases with congenital heart disease.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">PAA is defined by pulmonary artery dilatation of >40 mm,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> with some authors considering that dilatation >50 mm defines a giant aneurysm.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The clinical manifestations of PAA are diverse and non-specific. Symptoms include chest pain, dyspnea, cough, hemoptysis or palpitations.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1,8</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Nevertheless, it can be asymptomatic, only found incidentally on a routine imaging study such as a chest radiograph, as in our patient.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Imaging studies such as CT, echocardiography and cardiac catheterization aid in the diagnosis and prediction of complications, however the gold standard for establishing a diagnosis of PAA is pulmonary angiography.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">There is no consensus on the management of PAA, as different etiologies lead to different management approaches.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> In fact, since PAA is a rare lesion, there are no clear guidelines on treatment and patients have been managed individually.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Surgical intervention is generally recommended for symptomatic patients and in those with underlying diseases or complications, left-to-right shunt, pulmonary arterial hypertension and large aneurysm size (≥60 mm diameter).<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5,13–15</span></a> Nevertheless, some authors consider that PAA, even when very large, confer low risk in the presence of low pulmonary pressures, absence of congenital or acquired significant right shunt and no association with collagenopathies.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">7,15</span></a> As these patients have a relatively benign prognosis with an uncomplicated course, some authors, not surprisingly, argue that conservative management is a reasonable strategy.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">16,17</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">However, little is known about the natural history of PAA, and whatever treatment is chosen, close follow-up is essential.</p><p id="par0155" class="elsevierStylePara elsevierViewall">The approach to high-pressure PAA is even more controversial. Many authors support an aggressive surgical approach in a presence of severe complications such as airway compression,<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> pulmonary artery dissection<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> and intravascular thrombosis, with most reports describing an unfavorable evolution, such as low quality of life or even death, with medical treatment only.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4,9,20</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In the case presented, we describe the longest reported history of an uncomplicated giant high-pressure PAA, with at least 20 years of evolution without significant complications, favoring a conservative approach for such cases.</p><p id="par0165" class="elsevierStylePara elsevierViewall">In our case we suspect that the recent unfavorable evolution of COPD may have contributed to the patient's HF.</p><p id="par0170" class="elsevierStylePara elsevierViewall">According to the literature, intensification of specific pulmonary hypertension treatment improves airway compression. Maintenance of anticoagulation, although controversial, is usually needed due to the risk of PAA thrombosis. Nevertheless this may be need to be suspended in cases of hemoptysis, progressive growth of the PAA or concomitant dissection.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> In our case, although indicated, we decided not to start anticoagulation as we believed that the risk of death due to rupture of the PAA in a patient under anticoagulation was higher than the risk of thrombus formation.</p><p id="par0175" class="elsevierStylePara elsevierViewall">Treatment with conventional vasodilators is not recommended in this case since they may impair gas exchange due to the inhibition of hypoxic pulmonary vasoconstriction. In addition, loss of efficacy is observed after long-term use.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Therefore, as the patient had a stable evolution for more than 20 years and his current clinical condition was being treated medically, we decided to maintain a conservative approach and monitor the other clinical conditions.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0185" class="elsevierStylePara elsevierViewall">In the case presented, the recent onset of HF was explained by precapillary pulmonary hypertension associated with COPD in a patient with a giant high-pressure PAA.</p><p id="par0190" class="elsevierStylePara elsevierViewall">A surgical approach was considered, nevertheless, since our patient has severe lung disease which would have significantly increased the surgical risk, we decided not to follow this approach.</p><p id="par0195" class="elsevierStylePara elsevierViewall">In conclusion, giant high-pressure PAA is a rare condition for which in most cases surgical intervention is recommended, nevertheless, since our patient has had a stable evolution for more than 20 years, contradicting the accepted belief found in the literature, we decided to maintain a conservative approach and monitor the patient's comorbidities closely.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres613038" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec626821" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres613037" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec626822" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-04-02" "fechaAceptado" => "2015-06-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec626821" "palabras" => array:5 [ 0 => "Pulmonary artery aneurysm" 1 => "High pressure" 2 => "Pulmonary hypertension" 3 => "Chronic obstructive pulmonary disease" 4 => "Heart failure" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec626822" "palabras" => array:5 [ 0 => "Aneurisma da artéria pulmonar" 1 => "Altas pressões" 2 => "Hipertensão pulmonar" 3 => "Doença obstrutiva pulmonar crónica" 4 => "Insuficiência cardíaca" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The authors report the case of a 74-year-old man, with a history of chronic obstructive pulmonary disease (COPD), GOLD grade 3, stable for the past two decades, who was admitted to our center with severe right heart failure.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The chest radiograph showed moderate heart enlargement mainly of the right atrium and pulmonary artery, similar to previous chest radiographs in the previous 20 years. The transthoracic echocardiogram showed a pulmonary artery aneurysm (PAA), dilatation of the right chambers with pulmonary artery systolic pressure of 52 mmHg, and preserved right ventricular systolic function. A thoracic computed tomography scan confirmed the presence of a giant PAA 72 mm in diameter.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The patient was started on high-dose diuretics, with significant clinical improvement.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">After optimization of medical therapy right heart catheterization was carried out with the patient in optimal clinical condition, which revealed mild precapillary pulmonary hypertension with a mean pulmonary artery pressure of 26 mmHg.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">On the basis of the clinical and imaging findings a stable, giant, high-pressure, PAA was diagnosed secondary to pulmonary hypertension induced by COPD, with a 20-year follow-up without need for surgical repair, which helped in our decision to maintain medical surveillance. The recent onset of heart failure is explained by the unfavorable evolution of COPD.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This case may change the attitude expressed in previous studies favoring the choice of an invasive approach to treat giant high-pressure PAAs, instead supporting the maintenance of medical treatment.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os autores relatam o caso de um homem de 74 anos, com história de doença obstrutiva pulmonar crónica (DPOC), categoria C de GOLD, estável nas últimas duas décadas, admitido por insuficiência cardíaca grave de câmaras direitas.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Na radiografia torácica era evidente o alargamento da silhueta cardíaca, em particular da aurícula direita e artéria pulmonar, sendo sobreponível a radiografias torácicas realizadas ao longo dos últimos 20 anos. O ecocardiograma transtorácico documentou um aneurisma da artéria pulmonar (AAP), dilatação das câmaras direitas, com pressão sistólica da artéria pulmonar de 52 mmHg e função sistólica do ventrículo direito preservada. A TC torácica confirmou a presença de um aneurisma gigante da artéria pulmonar com 72 mm de diâmetro.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Iniciou-se terapêutica diurética intensiva, com melhoria clínica.</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Após otimização e com o doente clinicamente estável, foi realizado cateterismo cardíaco, que revelou hipertensão pulmonar pré-capilar ligeira com uma pressão da artéria pulmonar média de 26 mmHg.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Acreditamos que os dados clínicos e imagiológicos permitiram diagnosticar um aneurisma gigante da artéria pulmonar de altas pressões secundário a hipertensão pulmonar em contexto de DPOC, atualmente estável e com um seguimento de 20 anos sem necessidade de intervenção cirúrgica, que fundamentou a decisão de manter a vigilância médica, sendo a instalação recente de insuficiência cardíaca explicada pela progressão da DPOC.</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Este caso poderá alterar a ideia defendida em estudos prévios, que favorecia a escolha de uma abordagem invasiva no tratamento de aneurismas gigantes da artéria pulmonar de altas pressões, dando mais robustez à manutenção de um tratamento médico.</p></span>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 633 "Ancho" => 1490 "Tamanyo" => 63738 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Chest radiographs from 1992 (left) and 2011 (right) showing mediastinal enlargement.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 649 "Ancho" => 1500 "Tamanyo" => 113301 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Thoracic computed tomography scan, February 2011, revealing pronounced dilatation of the pulmonary trunk, with a maximum diameter of 72 mm, and enlargement of the main pulmonary arteries, 40 mm in diameter on the right and 33 mm in diameter on the left.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1448 "Ancho" => 3000 "Tamanyo" => 788332 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Electrocardiogram, February 2012, showing atrial fibrillation with a ventricular rhythm of 63/min, and no significant ST-T abnormalities.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 645 "Ancho" => 1500 "Tamanyo" => 95474 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Thoracic computed tomography angiography, March 2012, revealing a pulmonary artery aneurysm 72 mm in diameter.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aneurysm of the pulmonary artery: review of literature and report of a case" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.J. Deterling" 1 => "O. Clagett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "1947" "volumen" => "34" "paginaInicial" => "471" "paginaFinal" => "499" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20266464" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0110" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proximal pulmonary artery aneurysms in patients with pulmonary artery hypertension: complicated cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Sakuma" 1 => "J. Demachi" 2 => "J. Suzuki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intern Med" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "1789" "paginaFinal" => "1793" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17978536" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0115" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asymptomatic giant pulmonary artery aneurysm in an elderly male patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Khalil" 1 => "M. Al-Nozha" 2 => "B. Wani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Saudi Med J" "fecha" => "2004" "volumen" => "25" "paginaInicial" => "802" "paginaFinal" => "804" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15195216" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0120" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A ticking time bomb – high pressure pulmonary artery aneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "U. Fakler" 1 => "S. Mebus" 2 => "H. Kaemmerer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2008.06.005" "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2008" "volumen" => "121" "paginaInicial" => "777" "paginaFinal" => "780" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18724967" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0125" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aneurysms of the pulmonary arteries" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Bartter" 1 => "R. Irwin" 2 => "G. Nash" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1988" "volumen" => "94" "paginaInicial" => "1065" "paginaFinal" => "1075" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3053058" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0130" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Left main coronary artery and right pulmonary vein compression by a large pulmonary artery aneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Decuypere" 1 => "M. Delcroix" 2 => "W. Budts" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Heart" "fecha" => "2004" "volumen" => "90" "paginaInicial" => "e24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15084572" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0135" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low pressure giant pulmonary artery aneurysms in the adult: natural history and management strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Veldtman" 1 => "J. Dearani" 2 => "C. Warnes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2003" "volumen" => "89" "paginaInicial" => "1067" "paginaFinal" => "1070" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12923030" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0140" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aneurisma idiopático de la artéria pulmonar: presentación de un caso y revisión de la literatura" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. de Tomás Labat" 1 => "S. Beltrán Beltrán" 2 => "S. Molina Naveros" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Med Interna" "fecha" => "2005" "volumen" => "22" "paginaInicial" => "329" "paginaFinal" => "331" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16288578" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0145" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral pulmonary artery aneurysms in patients with pulmonary artery hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Sakuma" 1 => "J. Demachi" 2 => "J. Suzuki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Intern Med" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "979" "paginaFinal" => "984" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17603237" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0150" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary artery aneurysms and pseudoaneurysms in adults: findings at CT and radiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E. Nguyen" 1 => "C. Silva" 2 => "J. Seely" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "2007" "volumen" => "188" "paginaInicial" => "126" "paginaFinal" => "134" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0155" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant pulmonary artery aneurysm in a patient with vasoreactive pulmonary hypertension: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I. Araújo" 1 => "P. Escribano" 2 => "M. Lopez-Gude" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2261-11-64" "Revista" => array:5 [ "tituloSerie" => "BMC Cardiovasc Disord" "fecha" => "2011" "volumen" => "11" "paginaInicial" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22018102" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0160" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transesophageal echocardiographic detection of a pulmonary artery aneurysm complicated by thrombus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Guler" 1 => "M. Sakarya" 2 => "B. Eryonucu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Heart Lung" "fecha" => "2003" "volumen" => "32" "paginaInicial" => "159" "paginaFinal" => "161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12827100" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0165" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary arterial aneurysm: a pathologic study of five cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Butto" 1 => "R.J. Lucas" 2 => "J. Edwards" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1987" "volumen" => "91" "paginaInicial" => "237" "paginaFinal" => "241" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3802935" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0170" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rupture and dissection in pulmonary artery aneurysms: incidence, cause, and treatment: review and case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "O. Senbaklavaci" 1 => "Y. Kaneko" 2 => "A. Bartunek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mtc.2001.112634" "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "2001" "volumen" => "121" "paginaInicial" => "1006" "paginaFinal" => "1008" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11326255" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0175" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic pulmonary artery aneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Deb" 1 => "K. Zehr" 2 => "R. Shields" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2004.04.011" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2005" "volumen" => "80" "paginaInicial" => "1500" "paginaFinal" => "1502" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16181901" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0180" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical repair of the pulmonary trunk aneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Kuwaki" 1 => "K. Morishita" 2 => "H. Sato" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2000" "volumen" => "18" "paginaInicial" => "535" "paginaFinal" => "539" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11053813" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0185" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary artery aneurysm: is surgery always indicated?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Casselman" 1 => "B. Meyns" 2 => "P. Herygers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Cardiol" "fecha" => "1997" "volumen" => "52" "paginaInicial" => "431" "paginaFinal" => "436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9428941" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0190" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular causes of airway compression" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Kussman" 1 => "T. Geva" 2 => "F. McGowan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Paediatr Anesth" "fecha" => "2004" "volumen" => "14" "paginaInicial" => "60" "paginaFinal" => "74" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0195" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fatal pulmonary arterial dissection and sudden death as initial manifestation of primary hypertension: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Arena" 1 => "F. De Giorgio" 2 => "A. Abbate" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cardiovasc Pathol" "fecha" => "2004" "volumen" => "13" "paginaInicial" => "349" "paginaFinal" => "371" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0200" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications of proximal pulmonary artery aneurysms in patients with severe pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Hernández" 1 => "M.J. Ruiz-Cano" 2 => "P. Escribano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2010" "volumen" => "63" "paginaInicial" => "612" "paginaFinal" => "620" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20450857" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003500000003/v1_201603080050/S0870255116000172/v1_201603080050/en/main.assets" "Apartado" => array:4 [ "identificador" => "362" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Casos clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003500000003/v1_201603080050/S0870255116000172/v1_201603080050/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116000172?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 9 | 5 | 14 |
| 2024 Outubro | 45 | 49 | 94 |
| 2024 Setembro | 55 | 26 | 81 |
| 2024 Agosto | 59 | 37 | 96 |
| 2024 Julho | 38 | 30 | 68 |
| 2024 Junho | 40 | 19 | 59 |
| 2024 Maio | 48 | 19 | 67 |
| 2024 Abril | 50 | 25 | 75 |
| 2024 Maro | 41 | 34 | 75 |
| 2024 Fevereiro | 50 | 43 | 93 |
| 2024 Janeiro | 41 | 50 | 91 |
| 2023 Dezembro | 36 | 22 | 58 |
| 2023 Novembro | 35 | 24 | 59 |
| 2023 Outubro | 24 | 18 | 42 |
| 2023 Setembro | 40 | 28 | 68 |
| 2023 Agosto | 36 | 17 | 53 |
| 2023 Julho | 39 | 13 | 52 |
| 2023 Junho | 44 | 19 | 63 |
| 2023 Maio | 50 | 19 | 69 |
| 2023 Abril | 32 | 7 | 39 |
| 2023 Maro | 46 | 26 | 72 |
| 2023 Fevereiro | 37 | 22 | 59 |
| 2023 Janeiro | 38 | 9 | 47 |
| 2022 Dezembro | 51 | 15 | 66 |
| 2022 Novembro | 49 | 25 | 74 |
| 2022 Outubro | 62 | 22 | 84 |
| 2022 Setembro | 48 | 22 | 70 |
| 2022 Agosto | 52 | 36 | 88 |
| 2022 Julho | 64 | 36 | 100 |
| 2022 Junho | 49 | 27 | 76 |
| 2022 Maio | 61 | 30 | 91 |
| 2022 Abril | 71 | 25 | 96 |
| 2022 Maro | 83 | 39 | 122 |
| 2022 Fevereiro | 103 | 21 | 124 |
| 2022 Janeiro | 102 | 24 | 126 |
| 2021 Dezembro | 68 | 37 | 105 |
| 2021 Novembro | 73 | 35 | 108 |
| 2021 Outubro | 148 | 32 | 180 |
| 2021 Setembro | 79 | 37 | 116 |
| 2021 Agosto | 82 | 37 | 119 |
| 2021 Julho | 72 | 17 | 89 |
| 2021 Junho | 75 | 18 | 93 |
| 2021 Maio | 109 | 38 | 147 |
| 2021 Abril | 128 | 47 | 175 |
| 2021 Maro | 119 | 21 | 140 |
| 2021 Fevereiro | 87 | 17 | 104 |
| 2021 Janeiro | 54 | 11 | 65 |
| 2020 Dezembro | 35 | 11 | 46 |
| 2020 Novembro | 68 | 12 | 80 |
| 2020 Outubro | 58 | 15 | 73 |
| 2020 Setembro | 98 | 18 | 116 |
| 2020 Agosto | 40 | 5 | 45 |
| 2020 Julho | 67 | 15 | 82 |
| 2020 Junho | 66 | 7 | 73 |
| 2020 Maio | 59 | 4 | 63 |
| 2020 Abril | 59 | 18 | 77 |
| 2020 Maro | 46 | 8 | 54 |
| 2020 Fevereiro | 137 | 20 | 157 |
| 2020 Janeiro | 62 | 10 | 72 |
| 2019 Dezembro | 68 | 8 | 76 |
| 2019 Novembro | 70 | 9 | 79 |
| 2019 Outubro | 63 | 8 | 71 |
| 2019 Setembro | 114 | 5 | 119 |
| 2019 Agosto | 56 | 9 | 65 |
| 2019 Julho | 58 | 17 | 75 |
| 2019 Junho | 64 | 5 | 69 |
| 2019 Maio | 75 | 15 | 90 |
| 2019 Abril | 56 | 17 | 73 |
| 2019 Maro | 64 | 10 | 74 |
| 2019 Fevereiro | 54 | 12 | 66 |
| 2019 Janeiro | 59 | 8 | 67 |
| 2018 Dezembro | 76 | 17 | 93 |
| 2018 Novembro | 89 | 10 | 99 |
| 2018 Outubro | 246 | 31 | 277 |
| 2018 Setembro | 49 | 7 | 56 |
| 2018 Agosto | 83 | 16 | 99 |
| 2018 Julho | 38 | 4 | 42 |
| 2018 Junho | 70 | 8 | 78 |
| 2018 Maio | 82 | 9 | 91 |
| 2018 Abril | 95 | 10 | 105 |
| 2018 Maro | 130 | 10 | 140 |
| 2018 Fevereiro | 65 | 3 | 68 |
| 2018 Janeiro | 107 | 8 | 115 |
| 2017 Dezembro | 79 | 7 | 86 |
| 2017 Novembro | 33 | 12 | 45 |
| 2017 Outubro | 41 | 13 | 54 |
| 2017 Setembro | 63 | 6 | 69 |
| 2017 Agosto | 52 | 8 | 60 |
| 2017 Julho | 38 | 8 | 46 |
| 2017 Junho | 47 | 13 | 60 |
| 2017 Maio | 38 | 11 | 49 |
| 2017 Abril | 34 | 13 | 47 |
| 2017 Maro | 25 | 16 | 41 |
| 2017 Fevereiro | 34 | 5 | 39 |
| 2017 Janeiro | 36 | 1 | 37 |
| 2016 Dezembro | 35 | 13 | 48 |
| 2016 Novembro | 25 | 18 | 43 |
| 2016 Outubro | 42 | 13 | 55 |
| 2016 Setembro | 22 | 9 | 31 |
| 2016 Agosto | 23 | 13 | 36 |
| 2016 Julho | 12 | 7 | 19 |
| 2016 Junho | 2 | 13 | 15 |
| 2016 Maio | 5 | 23 | 28 |
| 2016 Abril | 39 | 9 | 48 |
| 2016 Maro | 110 | 66 | 176 |
Mostrar tudo
