Dissecção e rotura da artéria pulmonar associada a persistência do canal arterial: relato de um caso

Zamorano, Mabel de Moura Barros

doi:10.1590/S0102-76381987000200009

Resumos

É descrito um caso de dissecção da artéria pulmonar, com rotura intrapericárdica e tamponamento cardíaco, em menina de 13 anos de idade, portadora de canal arterial grande e valva pulmonar bicúspide. Havia hipertensão pulmonar com arteriopatia plexogênica grave; nas grandes artérias elásticas, a camada média tinha alterações necróticas e reparadoras profundas. Discute-se o papel da medionecrose, condição que é exacerbada pela hipertensão e por características individuais, na patogenia do aneurisma dissecante e no caso em questão. A análise da literatura mostra que, na artéria pulmonar, a dissecção é sempre um acidente fatal, por rotura ou obstrução arterial. O tratamento desta intercorrência, eminentemente cirúrgico, raramente é possível, devido ao caráter fulminante da evolução e à ausência de sinais definidos para o diagnóstico em tempo hábil.

Artéria pulmonar; persistência de canal arterial

The author presents a case of a 13-year old girl with pulmonary trunk dissection and rupture with a cardiac tamponade. There was a ductus arteriosus persistent and a non stenotic bicuspid pulmonary valve. A plexogenic pulmonary arteriopathy and severe process of injury and repair in the elastic vessels are present. The significance of medionecrosis in the pathogenesis ot pulmonary dissection is discussed. An analysis of reports in dissecting pulmonary aneurysm reveals a fatal outcome in the vast majority of them, due either to arterial rupture or obstruction.

pulmonary artery; patent ductus arteriosus

TRABALHOS ORIGINAIS

Dissecção e rotura da artéria pulmonar associada a persistência do canal arterial: relato de um caso

Dissection and rupture of pulmonary artery associated to patent ductus arteriosus: case report

Mabel de Moura Barros Zamorano

Do Instituto Dante Pazzanese de Cardiologia

^{Endereço para separatas} Endereço para separatas: Mabel Barros Zamorano Caixa Postal 215 São Paulo, SP, Brasil

RESUMO

É descrito um caso de dissecção da artéria pulmonar, com rotura intrapericárdica e tamponamento cardíaco, em menina de 13 anos de idade, portadora de canal arterial grande e valva pulmonar bicúspide. Havia hipertensão pulmonar com arteriopatia plexogênica grave; nas grandes artérias elásticas, a camada média tinha alterações necróticas e reparadoras profundas. Discute-se o papel da medionecrose, condição que é exacerbada pela hipertensão e por características individuais, na patogenia do aneurisma dissecante e no caso em questão. A análise da literatura mostra que, na artéria pulmonar, a dissecção é sempre um acidente fatal, por rotura ou obstrução arterial. O tratamento desta intercorrência, eminentemente cirúrgico, raramente é possível, devido ao caráter fulminante da evolução e à ausência de sinais definidos para o diagnóstico em tempo hábil.

Descritores: Artéria pulmonar, dissecção; persistência de canal arterial.

ABSTRACT

The author presents a case of a 13-year old girl with pulmonary trunk dissection and rupture with a cardiac tamponade. There was a ductus arteriosus persistent and a non stenotic bicuspid pulmonary valve. A plexogenic pulmonary arteriopathy and severe process of injury and repair in the elastic vessels are present. The significance of medionecrosis in the pathogenesis ot pulmonary dissection is discussed. An analysis of reports in dissecting pulmonary aneurysm reveals a fatal outcome in the vast majority of them, due either to arterial rupture or obstruction.

Descriptors: pulmonary artery, dissection; patent ductus arteriosus.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Entregue para publicação em 31 de julho de 1987.

Trabalho realizado no Instituto Dante Pazzanese de Cardiologia. São Paulo, SP, Brasil.

1 ALMEIDA, J. A. P. - Aneurismas de aorta e seus ramos: ênfase especial à medionecrose cística idiopática. Arq. Bras. Cardiol, 25 (3): 211-219, 1972.
2 BERNHEIM, J. & GRIFFEL, B. - A propos d'un cas d'anévrisme disséquant de l'artère pulmonaire. Ann Anat. Pathol. (Paris), 17 (1): 83-90, 1972.
3 BEST, J. - Dissecting aneurysm of the pulmonary artery. with multiple cardiovascular abnormalities and pulmonary hypertension. Med. J. Aust, 2 (25): 1129-1130, 1967.
4 CARLSON, R. G.; LILLEHEI, C. W.; EDWARDS, J. E. - Cystic medial necrosis of the ascending aorta in relation to age and hypertension. Am. J. Cardiol., 25 (4): 411-415, 1970.
5 COLEMAN, M.; SLATER, D.; BELL, R. - Rupture of pulmonary artery aneurysm associated with persistent ductus arteriosus. Br. Heart J.; 44 (4): 464-468, 1980.
6 CRUMPTON, M. - Congenital heart disease and dissecting aneurysm of pulmonary artery. Br. Med. J, 1: 1303, 1950.
7 D'ARBELA, P. G.; MUGERWA, J. W.; PATEL, A. K.; SOMERS, K. - Aneurysm of pulmonary artery with persistent ductus arteriosus and pulmonar infundibular stenosis fatal dissection and rupture in pregnancy. Br. Heart J, 32 (1) 124-126, 1970.
8 DENNISON, A. R.; WATKINS, R. M.; GUNNING, A. J. - Simultaneous aortic and pulmonary artery aneurysm due to giant cell arteritis. Thorax, 40 (2): 156-157, 1985.
9 DETTERLING Jr., R. A. & CLAGETT, O. T. - Aneurysm of pulmonary artery: review of the literature and report of a case. Am. Heart J, 34 (1): 471-499, 1947.
10 FAVORITE, G. O. - Cor biatriatum triloculare with rudimentary right ventricle, hypoplasia of transposed aorta and patent dictus arteriosus, terminating by rupture of dilated pulmonary artery. Am. J. Med. Sci, 187 (5): 653-671, 1934.
11 FOORD, A. G. & LEWIS, R. D. - Primary dissecting aneurysm of peripheral and pulmonary arteries: dissecting hemorrhage of media. Arch. Pathol, 68: 553-577, 1959.
12 GILLAN, J. E.; COSTIGAN, D. C.; KEELEY, F. M.; ROSE, V. - Spontaneous dissecting aneurysm of the ductus arteriosus in an infant with Marfan syndrome. J. Pediatrics, 105 (6): 952-955, 1984.
13 GOMEZ-ARNAU, J.; MONTERO, C. G.; LUENGO, C.; GILSANZ, F. J.; AVELLO, F. - Pulmonary dissection and rupture of pulmonary artery after catheter use in pulmonary hypertension. Critical Care Med, 10 (10): 694-695, 1982.
14 GORE, I. & HIRST Jr., A. E. - Dissecting aneurysm of the aorta. Progr. Cardiovasc. Dis, 16 (2): 103-111, 1973.
15 GROVER, R. F.; VOGE, J. H. K.; AVERILL, K. H.; BLOUNT, S. G. - Pulmonary hypertension: individual and species variability relative to vascular reactivity. Am. Heart j. 66(1): 1-3, 1963.
16 HANKINS, G. D.; BREKKEN, A. L.; DAVIS, L. M. - Maternal death secondary to a dissecting aneurysm of the pulmonary artery. Obstet. Gynecol, 65 (Supl. 3): 45-48, 1985.
17 HEATH, D.; DUSHANE, J. W.; WOOD, E. H.; EDWARDS, J. E. - The structure of the pulmonary trunk at diferent ages and in cases of pulmonary hypertension and pulmonary stenosis. J. Pathol. Bacteriol. 77 (2): 443-456, 1959.
18 HEATH, D. & EDWARDS, J. E. - Configuration of elastic tissue of pulmonary trunk in idiopathic pulmonary hypertension. Circulation, 21 (1): 59-62, 1960.
19 KLIMA, T.; COELHO, A.; GRAY, A. G.; WUKASCH, D. C.; REUL Jr., G. J.; COOLEY, D. A. - The morphology of ascending aortic aneurysms. Hum. Pathol, 14 (9): 810-817, 1983.
20 LEVY, H. - Partial rupture of pulmonary artery with lesions of medionecrosis in a case of mitral stenosis. Am. Heart J, 62 (1): 31-42, 1961.
21 LUCHTRATH, H. - Dissecting aneurysm of the pulmonary artery. Virchows. Arch. (Pathol. Anat.), 391: 241-247, 1981.
22 MIZIARA, H. L.; FILOMENO, A. P.; YUNES, M. A. F. - Aneurisma dissecante de artéria pulmonar associado a esquistossomose pulmonar: relato de um caso. Arq. Bras. Cardiol, 37(2): 107-110, 1981.
23 PLACIK, B.; RODBARD, S.; McMAHON, J.; SWAROOP, S. - Pulmonary artery dissection and rupture in Eisenmenger's syndrome. Vasc. Surg, 10 (2): 72-80, 1976.
24 RAVINES, H. T. - Dissecting hematomas of intrapulmonary arteries in a case of pulmonary hypertension associated with patent ductus arteriosus. J. Thorac. Cardiovasc. Surg, 39 (6): 760-766, 1960.
25 ROBERTS, W. C. - Aortic dissection: anatomy, consequences, and causes. Am. Heart J, 101 (2): 195-214, 1981.
26 ROSENBLUM, S. E.; RATLIFF, N. B.; SHIREY, E. K.; SEDMAK, D. D.; TAYLOR, P. C. - Pulmonary artery dissection induced by a Swan-Ganz catheter. Cleve. Clin. O, 51 (4): 671-675, 1984.
27 SHILKIN, K. B.; LOW, L. P.; CHEN, B. T. M. - Dissecting aneurysm of the pulmonary artery. J. Pathol., 98:25-29, 1969.
28 SCHLATMANN, T. J. M. & BECKER, A. E. - Histologic changes in the normal aging aorta: implications for dissecting aortic aneurysm. Am. J. Cardiol, 39 (1). 13-20, 1977.
29 SCHLATMANN, T. J. M. & BECKER, A. E. - Pathogenesis of dissecting aneurysm of aorta: comparative histopathologic study of significance of medial changes. Am. J. Cardiol., 39 (1): 21-26, 1977.
30 SCHLICHTER, J. G.; AMROMIN, G. D.; SOLWAY, A. J. L. - Dissecting aneurysms of the aorta. Arch. Int. Med, 84: (1): 558-568, 1949.
31 SHULL, W. K.; KAPADIA, S. B.; ZUBERBUHLER, J. R. - Aneurysm of the main pulmonary artery: association with patent ductus and ostium secundum defect. Am. J. Dis. Child, 119 (6): 507-509, 1970.
32 THOMAS, G. C.; WHITELAW, D. M.; TAYLOR, H. E. - Rupture of the pulmonary artery complicating rheumatic mitral stenosis. Arch. Pathol, 60: 99-103, 1955.
33 TREDAL, S. M.; CARTER, J. B.; EDWARDS, J. R. - Cystic medial necrosis of the pulmonary artery: association with pulmonary hypertension. Arch. Pathol, 97: 183-186, 1974.
34 WHITAKER, W.; HEATH, D.; BROWN, J. W. - Patent ductus arteriosus with pulmonary hypertension. Br. Heart J, 17(2): 121-137, 1955.

Endereço para separatas:

Mabel Barros Zamorano

Caixa Postal 215

São Paulo, SP, Brasil

Datas de Publicação

Publicação nesta coleção
16 Fev 2011
Data do Fascículo
Ago 1987

Histórico

Recebido
31 Jul 1987

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1 ALMEIDA, J. A. P. - Aneurismas de aorta e seus ramos: ênfase especial à medionecrose cística idiopática. Arq. Bras. Cardiol, 25 (3): 211-219, 1972.

[2] 2 BERNHEIM, J. & GRIFFEL, B. - A propos d'un cas d'anévrisme disséquant de l'artère pulmonaire. Ann Anat. Pathol. (Paris), 17 (1): 83-90, 1972.

[3] 3 BEST, J. - Dissecting aneurysm of the pulmonary artery. with multiple cardiovascular abnormalities and pulmonary hypertension. Med. J. Aust, 2 (25): 1129-1130, 1967.

[4] 4 CARLSON, R. G.; LILLEHEI, C. W.; EDWARDS, J. E. - Cystic medial necrosis of the ascending aorta in relation to age and hypertension. Am. J. Cardiol., 25 (4): 411-415, 1970.

[5] 5 COLEMAN, M.; SLATER, D.; BELL, R. - Rupture of pulmonary artery aneurysm associated with persistent ductus arteriosus. Br. Heart J.; 44 (4): 464-468, 1980.

[6] 6 CRUMPTON, M. - Congenital heart disease and dissecting aneurysm of pulmonary artery. Br. Med. J, 1: 1303, 1950.

[7] 7 D'ARBELA, P. G.; MUGERWA, J. W.; PATEL, A. K.; SOMERS, K. - Aneurysm of pulmonary artery with persistent ductus arteriosus and pulmonar infundibular stenosis fatal dissection and rupture in pregnancy. Br. Heart J, 32 (1) 124-126, 1970.

[8] 8 DENNISON, A. R.; WATKINS, R. M.; GUNNING, A. J. - Simultaneous aortic and pulmonary artery aneurysm due to giant cell arteritis. Thorax, 40 (2): 156-157, 1985.

[9] 9 DETTERLING Jr., R. A. & CLAGETT, O. T. - Aneurysm of pulmonary artery: review of the literature and report of a case. Am. Heart J, 34 (1): 471-499, 1947.

[10] 10 FAVORITE, G. O. - Cor biatriatum triloculare with rudimentary right ventricle, hypoplasia of transposed aorta and patent dictus arteriosus, terminating by rupture of dilated pulmonary artery. Am. J. Med. Sci, 187 (5): 653-671, 1934.

[11] 11 FOORD, A. G. & LEWIS, R. D. - Primary dissecting aneurysm of peripheral and pulmonary arteries: dissecting hemorrhage of media. Arch. Pathol, 68: 553-577, 1959.

[12] 12 GILLAN, J. E.; COSTIGAN, D. C.; KEELEY, F. M.; ROSE, V. - Spontaneous dissecting aneurysm of the ductus arteriosus in an infant with Marfan syndrome. J. Pediatrics, 105 (6): 952-955, 1984.

[13] 13 GOMEZ-ARNAU, J.; MONTERO, C. G.; LUENGO, C.; GILSANZ, F. J.; AVELLO, F. - Pulmonary dissection and rupture of pulmonary artery after catheter use in pulmonary hypertension. Critical Care Med, 10 (10): 694-695, 1982.

[14] 14 GORE, I. & HIRST Jr., A. E. - Dissecting aneurysm of the aorta. Progr. Cardiovasc. Dis, 16 (2): 103-111, 1973.

[15] 15 GROVER, R. F.; VOGE, J. H. K.; AVERILL, K. H.; BLOUNT, S. G. - Pulmonary hypertension: individual and species variability relative to vascular reactivity. Am. Heart j. 66(1): 1-3, 1963.

[16] 16 HANKINS, G. D.; BREKKEN, A. L.; DAVIS, L. M. - Maternal death secondary to a dissecting aneurysm of the pulmonary artery. Obstet. Gynecol, 65 (Supl. 3): 45-48, 1985.

[17] 17 HEATH, D.; DUSHANE, J. W.; WOOD, E. H.; EDWARDS, J. E. - The structure of the pulmonary trunk at diferent ages and in cases of pulmonary hypertension and pulmonary stenosis. J. Pathol. Bacteriol. 77 (2): 443-456, 1959.

[18] 18 HEATH, D. & EDWARDS, J. E. - Configuration of elastic tissue of pulmonary trunk in idiopathic pulmonary hypertension. Circulation, 21 (1): 59-62, 1960.

[19] 19 KLIMA, T.; COELHO, A.; GRAY, A. G.; WUKASCH, D. C.; REUL Jr., G. J.; COOLEY, D. A. - The morphology of ascending aortic aneurysms. Hum. Pathol, 14 (9): 810-817, 1983.

[20] 20 LEVY, H. - Partial rupture of pulmonary artery with lesions of medionecrosis in a case of mitral stenosis. Am. Heart J, 62 (1): 31-42, 1961.

[21] 21 LUCHTRATH, H. - Dissecting aneurysm of the pulmonary artery. Virchows. Arch. (Pathol. Anat.), 391: 241-247, 1981.

[22] 22 MIZIARA, H. L.; FILOMENO, A. P.; YUNES, M. A. F. - Aneurisma dissecante de artéria pulmonar associado a esquistossomose pulmonar: relato de um caso. Arq. Bras. Cardiol, 37(2): 107-110, 1981.

[23] 23 PLACIK, B.; RODBARD, S.; McMAHON, J.; SWAROOP, S. - Pulmonary artery dissection and rupture in Eisenmenger's syndrome. Vasc. Surg, 10 (2): 72-80, 1976.

[24] 24 RAVINES, H. T. - Dissecting hematomas of intrapulmonary arteries in a case of pulmonary hypertension associated with patent ductus arteriosus. J. Thorac. Cardiovasc. Surg, 39 (6): 760-766, 1960.

[25] 25 ROBERTS, W. C. - Aortic dissection: anatomy, consequences, and causes. Am. Heart J, 101 (2): 195-214, 1981.

[26] 26 ROSENBLUM, S. E.; RATLIFF, N. B.; SHIREY, E. K.; SEDMAK, D. D.; TAYLOR, P. C. - Pulmonary artery dissection induced by a Swan-Ganz catheter. Cleve. Clin. O, 51 (4): 671-675, 1984.

[27] 27 SHILKIN, K. B.; LOW, L. P.; CHEN, B. T. M. - Dissecting aneurysm of the pulmonary artery. J. Pathol., 98:25-29, 1969.

[28] 28 SCHLATMANN, T. J. M. & BECKER, A. E. - Histologic changes in the normal aging aorta: implications for dissecting aortic aneurysm. Am. J. Cardiol, 39 (1). 13-20, 1977.

[29] 29 SCHLATMANN, T. J. M. & BECKER, A. E. - Pathogenesis of dissecting aneurysm of aorta: comparative histopathologic study of significance of medial changes. Am. J. Cardiol., 39 (1): 21-26, 1977.

[30] 30 SCHLICHTER, J. G.; AMROMIN, G. D.; SOLWAY, A. J. L. - Dissecting aneurysms of the aorta. Arch. Int. Med, 84: (1): 558-568, 1949.

[31] 31 SHULL, W. K.; KAPADIA, S. B.; ZUBERBUHLER, J. R. - Aneurysm of the main pulmonary artery: association with patent ductus and ostium secundum defect. Am. J. Dis. Child, 119 (6): 507-509, 1970.

[32] 32 THOMAS, G. C.; WHITELAW, D. M.; TAYLOR, H. E. - Rupture of the pulmonary artery complicating rheumatic mitral stenosis. Arch. Pathol, 60: 99-103, 1955.

[33] 33 TREDAL, S. M.; CARTER, J. B.; EDWARDS, J. R. - Cystic medial necrosis of the pulmonary artery: association with pulmonary hypertension. Arch. Pathol, 97: 183-186, 1974.

[34] 34 WHITAKER, W.; HEATH, D.; BROWN, J. W. - Patent ductus arteriosus with pulmonary hypertension. Br. Heart J, 17(2): 121-137, 1955.