E-page Original Images: Left main coronary artery compression by a giant pulmonary artery aneurysm associated with large atrial septal defect and severe pulmonary hypertension

A 27-year-old woman having exercise intolerance, shortness of breath and substernal chest pain was admitted to our institution. On admission, physical examination revealed, a blood pressure of 110/60 mmHg, 2/6 midsystolic murmur at the apex, 3/6 systolic murmur in the tricuspid area and fixed splitting of the second heard sound during all respiration phases. Chest X-ray showed cardiomegaly and a prominent bilateral pulmonary artery enlargement (Fig.1). Transthoracic echocardiography was performed for the first time in her life, and it revealed an 1.8 cm in size prominent secundum type atrial septal defect with severe pulmonary hypertension and dilated right cardiac chambers (Fig. 2, Video 1. See corresponding video/movie images at www.anakarder.com). Moreover a giant pulmonary artery aneurysm (5.3 cm) was seen on the parasternal short-axis view.