Severe pulmonary hypertension secondary to giant chronic dissecting aortic aneurysm presenting as chronic right heart failure.

We report on an 81-year-old woman who presented to hospital with effort dyspnea and leg edema. Transthoracic echocardiography revealed normal left ventricular function but marked dilated ascending aorta with an intimal flap in the proximal ascending aorta, severe tricuspid regurgitation, and severe pulmonary hypertension. Contrast enhanced multi-slice computerized tomography of the chest was performed for detailed evaluation of aortic dissection and this also showed the intimal flap of the ascending aortic dissection (DeBakey type II) and giant ascending aorta (10.5 cm) compressing the main and right pulmonary artery. This is the first case where chronic right heart failure is caused by chronic aortic dissection.

Objective: Although dissecting aortic aneurysms generally present acutely, they may have chronic presentation. Obstruction of the pulmonary artery caused by a dissecting aortic aneurysm, which mimics acute pulmonary thromboembolism, is one of the rare acute presentations. In this paper, we suggest a giant dissecting aortic aneurysm compressing pulmonary artery substantially may also lead severe pulmonary hypertension and symptoms of chronic right heart failure.>.