4 CONCLUSION
Patients with PAH and giant PAA may be challenging and potentially carry high surgical risk. These patients should be evaluated by an experienced heart and lung transplantation centers. Strategies can be variable depending upon underlying disease, etiology, center dependent expertise, and resources available. In those patients who are refractory to medical therapy, transplantation may be the only management option. Multidisciplinary consensus should be obtained to offer patients individualised treatment options. Replacement or reconstruction of the pulmonary trunk is a feasible option for those who do not require heart-lung transplantation.