Images in Cardiovascular Medicine Hoarseness and Chest Pain in Eisenmenger Syndrome With Pulmonary Artery Aneurysm

A 62-year-old woman presented with a 4-month history ofpersistent and progressively worsening left upper chest pain despite analgesia. One month prior, she had noticed a hoarseness of voice. Physical examination at the time re-vealed cyanosis, clubbing of hands and feet, and pulmonary regurgitation murmur but no right ventricular failure. There was prominent bulging of her rib cage over the left upper precordium. Cardiac catheterization at 12 years of age had confirmed Eisenmenger syndrome (with mean pulmonary arterial pressure of 86 mm Hg) due to an atrial septal defect and significant shunt reversal. In recent years, she had progressive dilation of her pulmonary arterial trunk despite phosphodiesterase inhibitor treatment for 6 years. A transthoracic echocardiogram revealed an aneurysmal pulmonary arterial trunk with severely elevated right ventric-ular systolic pressure at 84 mm Hg and right ventricula