Right Heart Failure Secondary to Compression of the Right Pulmonary Artery by a Large Proximal Aortic Aneurysm

A 73-year-old woman, who was known to have a large proximal aortic aneurysm, was referred from the Gastroenterology Department for reevaluation for possible aortic surgery. At that time, she complained of fatigue and shortness of breath, which corresponded to New York Heart Association class III symptoms.The patient had initially consulted us 1 year before this presentation. She had been diagnosed recently as having gastric cancer at that time, and additional tests revealed that she also had a proximal aortic aneurysm. Although the aneurysm was large, with a maximum diameter of 67 mm, her gastric cancer, classified as being in stage 4, was considered inoperable. The gastroenterologist estimated that she could probably live for ≈1 year. We discussed the options with the patient, and she rationally decided not to undergo aortic surgery at that time. She did not have any cardiac-related symptoms at that time. A chest radiograph showed a right-sided bulge of the mediastinum (Figure 1).Figure 1. A , A chest radiograph taken at the patient’s first visit …