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(Circulation. 2005;112:e76-e78.)
© 2005 American Heart Association, Inc.

Images in Cardiovascular Medicine

Severe Pulmonary Artery Stenosis Caused by Extrinsic Compression of a Calcified Circular Ring

Woong Chol Kang, MD; Chul Hyun Park, MD; Wook-Jin Chung, MD; Seung Hwan Han, MD; Tae Hoon Ahn, MD; Eak Kyun Shin, MD

From Cardiology (W.C.K., W.-J.C., S.H.H., T.H.A., E.K.S.) and Cardiovascular Surgery (C.H.P.), Gil Heart Center, Gachon Medical School, Incheon, Korea.

Correspondence to Eak Kyun Shin, MD, Cardiology, Gil Heart Center, Gachon Medical School, 1198 Kuwol-dong, Namdong-gu, Incheon, Korea 405-760. E-mail ekshin@gilhospital.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 35-year-old man visited our hospital with dyspnea on exertion and edema on his face and both legs that had grown worse over several months. He had a 15-year-long history of treatment for pulmonary tuberculosis. On physical examination, a grade 4/6 pansystolic murmur was heard at the 4th intercostal space along the left sternal border. Chest radiography revealed enlargement of the right ventricle and the left pulmonary trunk. Interestingly, a calcified circular ring was noted around the great vessels (Figure 1). Echocardiography showed severe pulmonary hypertension (98.1 mm Hg) caused by severe stenosis of the main pulmonary artery at the supravalvular level, which resulted in enlarged right artery and right ventricle chamber dimensions (Figure 2A and 2B). Right heart catheterization demonstrated elevated right ventricle pressure (71 mm Hg), even though we used the full dose of medication to reduce preload and afterload (Figure 2C). On chest CT angiogram, there was a calcified ring encircling the ascending aorta and the main pulmonary artery, and the main pulmonary artery was compressed by that ring with poststenotic dilatation (Figure 3A and 3B). Pulmonary artery angiogram also showed similar findings (Figure 3C). Surgery was performed, and the calcified ring was removed entirely except for the posterior portion, which had adhered tightly to the aorta (Figure 4). Biopsy specimens showed an extensive dystrophic calcification and dense fibrosis. After removing the calcified ring, graft repair was performed at the stenotic area of the main . . . [Full Text of this Article]

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Circulation 2005 112: 777. [Extract] [Full Text]