Pulmonary artery pseudoaneurysm in a patient with aortic valve stenosis

A 77-year-old, high-risk woman with symptomatic aortic valve stenosis (aortic valve area 0.77 cm(2)) underwent coronary artery catheterization and right heart catheterization. After catheterization, she suddenly developed hemoptysis, and became hypoxic and hypotonic. She was intubated and the bleeding was stopped using positive end-expiratory pressure. Chest X-ray and computed tomography showed a pulmonary artery (PA) pseudoaneurysm with a maximum diameter of 40 mm at the right middle lobe. Endovascular treatment approaches by coil embolization failed, so surgical resection was indicated. In preparation for the procedure and to reduce perioperative risk, transapical aortic valve implantation was performed. The operation took about 40 minutes and the intraoperative activated clotting time was controlled at 180-200 sec. After successful transapical aortic valve implantation, aneurysmectomy was performed. Intraoperatively, the PA pseudoaneurysm was found to occupy nearly the entire middle lobe. A right middle lobectomy was performed. The operative course was uneventful. Transapical aortic valve implantation may have eliminated the risk of rupture or re-bleeding in such bleeding-prone patient.