Composite Graft Reconstruction for Pulmonary Artery Aneurysm Occurring Late After Surgical Pulmonary Valvotomy

Pulmonary artery aneurysm (PAA) is considered an uncommon condition, and surgical indications remain unclear. In contrast, pulmonary stenosis (PS) is a common congenital heart disease that often results in pulmonary regurgitation (PR) after intervention and may sometimes require reintervention. In cases of PAA following repair of PS, the caliber mismatch between the dilated pulmonary artery (PA) and the small valve annulus complicates surgery. A composite graft is well-suited to address this issue. A patient underwent surgical valvotomy for PS at age 16. She remained asymptomatic until pregnancy at age 32, when routine cardiac screening was normal; she was then lost to follow-up. At age 72, dyspnea and leg edema led to the diagnosis of combined valvular disease and a 68-mm PAA. Imaging revealed severe PR and right ventricular dysfunction. PA and right ventricular outflow tract reconstruction were performed with a composite graft in a Rastelli-type procedure, along with mitral valve replacement for atrial functional mitral regurgitation and tricuspid annuloplasty for secondary tricuspid regurgitation, in the setting of combined valvular disease complicated by heart failure (HF). The postoperative course was uneventful, and at two years of follow-up, no HF or PA enlargement was observed. This case demonstrates that successful one-stage surgery can be performed in an elderly patient with a PAA and combined valvular disease. A Rastelli-type reconstruction effectively addressed the mismatch between the pulmonary valve and the aneurysmal artery, optimizing hemodynamics and preserving pulmonary flow. Long-term follow-up remains essential to monitor residual tissue and potential late complications.