Left main coronary artery aneurysm

Left main coronary aneurysm is extremely uncommon and its precise pathogenesis remains poorly understood. They are associated with serious complications and treatment is still the subject of disagreement. The authors present the case of a 42-year-old man admitted for a coronary syndrome, whose coronary angiogram revealed a large left main coronary aneurysm. The echocardiogram and multi-row detector CT angiography confirmed the abnormalities observed. No positive findings resulted from etiological evaluation. We decided to maintain the patient under oral anticoagulation and he remains clinically stable after two years of follow-up.

Multiple spontaneous coronary artery dissection associated with Trousseau's syndrome

Spontaneous coronary artery dissection (SCAD) remains a rare cause of acute coronary syndrome. SCAD has been observed in three groups of patients: those with coronary atherosclerosis, women in the peripartum period, and an idiopathic group. SCAD may also be associated with some other conditions. Herein, we present a 57 year-old man who developed SCAD concomitant with Trousseau's syndrome secondary to colon adenocarcinoma.

Spontaneous coronary artery dissection: case series and review

Spontaneous coronary artery dissection (SCAD) is a rare but important cause of acute coronary syndromes. SCAD can cause unstable angina, acute myocardial infarction, and sudden death. Predisposing factors include atherosclerosis, the peripartum period, and structural and inflammatory conditions affecting the arterial wall. The diagnosis of coronary dissection is usually made by coronary angiography. Prompt diagnosis and treatment of patients with dissection improves survival. Therapeutic options include medical therapy, percutaneous coronary intervention, and surgery. We present a series of patients with spontaneous coronary artery dissection at our institution. The etiology, pathogenesis, diagnosis, treatment, and prognosis of patients with coronary dissection are reviewed.

Postpartum spontaneous coronary artery dissection (SCAD) managed conservatively

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and has been described in young women during the peripartum period. Management of these patients has been controversial. A 35 year old Caucasian female, 11 days postcesarean section delivery presented with acute myocardial infarction. She underwent angiography within a few hours of presentation, which showed dissection of LAD. Repeat angiography six days later showed improvement of dissection. Patient showed clinical improvement on conservative treatment and no recurrence of symptoms over the past two years follow-up. There is no consensus on the treatment and our case is one of the cases managed successfully with conservative treatment.

Spontaneous healing of spontaneous coronary artery dissection: a case report

Spontaneous coronary artery dissection (SCAD) is an extremely rare cause of myocardial ischemia. It is more prevalent in young women, particularly in the peripartum period. We report a case of SCAD occurring in a 40-year-old non-pregnant woman who presented with acute coronary syndrome. Coronary angiography revealed dissection in the mid and distal portions of left anterior descending artery. She was treated with medical therapy and repeat coronary angiography at 2 months showed no signs of the previous dissection.

Idiopathic spontaneous coronary artery dissection presenting as acute myocardial infarction in a young boy

Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction. It is more commonly seen in the younger age group particularly in women. We report a case of 14-year-old boy that presented with acute myocardial infarction (MI), with left ventricular (LV) dysfunction and was detected to have left main coronary artery dissection on coronary angiography. Myocardial perfusion imaging did not show any evidence of reversible ischemia. Patient was managed conservatively and was marginally improved. This case highlights one of the rare causes of myocardial infarction and the use of myocardial perfusion imaging in selecting treatment options for management of this rare entity.

[Prevention of thrombosis of coronary aneurysms in patients with a history of Kawasaki disease]

Patients with coronary artery aneurysms caused by Kawasaki disease are at increased risk of coronary thrombosis and ischemia. To prevent coronary thrombosis, long-term anti-thrombosis using anti-platelet drugs, such as aspirin, dipyridamole, ticlopidine, clopidogrel, and abciximab, with or without warfarin is recommended by official guidelines. In fact, aspirin or aspirin with warfarin are the most frequently administered regimen in these patients with coronary aneurysms. However, there has been paucity of data and no randomized controlled study to determine the efficacy of these drugs. This short article attempts to summarize the efficacy and safety of these drugs based on currently available literatures and our multi-institutional experience.

Successful management of an unruptured mycotic coronary aneurysm

Systemic complications of native-valve endocarditis include embolism, abscess formation and development of mycotic aneurysms. To date, only two cases of mycotic coronary aneurysm (MCA) detected by transesophageal echocardiography (TEE) have been reported since 1812. We describe the successful management of infectious mitral valve endocarditis complicated by a MCA involving the left circumflex artery initially detected by TEE. This report illustrates the importance of correlating findings between TEE and coronary angiography, as early detection and prompt management of these rare coronary aneurysms are of paramount importance.

Complete angiographic resolution of spontaneous coronary artery dissection associated with sleep deprivation

We describe a case of complete angiographic resolution of spontaneous coronary artery dissection associated sleep deprivation with a successful medical management. A 40-year-old woman presented to our emergency department with squeezing chest pain following 72 h sleep deprivation. Coronary angiography demonstrated longitudinal dissection of the middle part of the diagonal artery with TIMI III flow to the distal part of the vessel. The dissected vessel was small to intervene so we decided to treat it conservatively with antiplatelet agents and heparin. She remained free of chest pain during the hospitalization period and was discharged in good condition. We continued to treat her in the outpatient clinic with antiplatelet agents and the patient no longer complained of chest pain. At six months, coronary angiography demonstrated complete resolution of the previously dissected coronary artery.

Spontaneous coronary artery dissection and pulmonary thromboembolism: a case report

Spontaneous coronary artery dissection (SCAD) still is a rare cause of acute coronary syndrome. SCAD has been observed in three groups of patients: those with coronary atherosclerosis, peripartal women and idiopathic group. SCAD may be associated with some conditions. We report an unusual association: SCAD and pulmonary thromboembolism.

Case report: a very large dissection in the left anterior descending coronary artery of a 56-year-old man

Spontaneous coronary artery dissection (SCAD) is a rare condition that usually occurs in relatively young patients who are predominantly female. Seldom it could be a cause of acute myocardial ischemia leading to a sudden cardiac death. SCAD consists of intramural hematoma formation or, rarely, intimal tears that initiate and propagate the dissection in the vessel wall. In rare cases, the SCAD occurs in male patients. We report the case of a 56-year-old man with acute myocardial infarction who was successfully treated via systemic thrombolysis in a peripheral hospital. Associated conditions were thrombosis of right femoral artery in the past and high platelet count (800,000/mm3). After 1 month, elective coronary angiography revealed a very diffuse spiral dissection of the left anterior descending artery; hence, our choice of medical treatment consisted of double oral antiplatelet therapy (clopidogrel 75 mg plus aspirin 325 mg once daily). After a 2-year follow-up, there was absence of both angina and myocardial ischemia and there was a decrease in platelet count. Many strategies could be considered in patients with SCAD, such as PCI, bypass surgery, or conservative medical management. In general, the long-term prognosis of patients with SCAD is considered favorable if they survive the acute phase.

Successful surgical treatment of an infected right coronary artery aneurysm-to-right ventricle fistula after sirolimus-eluting stent implantation

The development of infected coronary aneurismal fistula following stenting seems exceedingly rare. A sirolimus-eluting stent (SES) was implanted in a 70-year-old male patient for acute coronary syndrome. His fever persisted despite treatment with adapted antibiotics. Coronary angiography and 16-multidetector row computed tomography demonstrated the huge right coronary aneurysm forming a fistula to the right ventricle. The aneurysm was excised by surgical treatment. Histopathological examination of the resected mass revealed leucocyte infiltration at the stent site, which lead to the diagnosis of mycotic aneurysm. SESs may play a potential role in locally blunting the innate response to bacterial agents.

Right coronary artery aneurysm

Coronary artery aneurysms, characterized by abnormal dilatations of a localized portion of the coronary artery, are an uncommon finding during angiography. We present a case where a giant right coronary aneurysm was detected during angiography, in a patient admitted with a inferior wall myocardial infarction.

Recurrent spontaneous coronary artery dissection with transient left ventricular systolic dysfunction

Spontaneous coronary artery dissection (SCAD) is a potentially life-threatening entity with a variety of clinical presentations. We report a patient who presented with chest pain and angiographic evidence of coronary dissection. Due to the rapid resolution of symptoms and benign-appearing nature of the dissection, no intervention was pursued and the patient was maintained on medical therapy. She represented 2 days later with substernal chest pain, dynamic EKG changes, positive cardiac biomarkers and a transient depression of her left ventricular function.

Additional value of computed tomography angiography in multiple coronary artery aneurysms--a case report

Though invasive coronary angiography is the gold standard for the diagnosis of coronary artery aneurysms, computed tomography angiography may be just as useful in providing details of their morphology, size, location and associated stenosis or ectasia. Besides, it has the advantage of being a non-invasive modality.We present a case in which an aneurysm, which was not identified by conventional angiography due to the presence of thrombus, was correctly identified by computed tomography angiography.

[Clinical analysis of 942 cases of Kawasaki disease]

OBJECTIVE

The study was designed to investigate the clinical characteristics and the effects of therapeutic proposal on Kawasaki disease (KD).

METHODS

Clinical features, diagnosis and treatment for totally 942 patients with KD hospitalized during Jan, 2000 to Dec, 2004 were reviewed. Clinical features of typical and incomplete KD were compared. Also, influential factors for KD resistant to intravenous immune globulin (IVIG) therapy were analyzed. Five hundred and ten cases were followed up for analyzing the prognosis of coronary artery lesion (CAL).

RESULTS

(1) 774 cases were diagnosed as typical KD, and 168 cases as incomplete KD. The incidence of infants with incomplete KD was higher than that of infants with typical KD (18.5% vs. 10.1%, P < 0.01). As compared with typical KD, the cases of incomplete KD had a long duration of fever before final diagnosis [(7.7 +/- 2.9) d vs. (7.0 +/- 2.4) d, P < 0.01], high hemoglobin level [Hb, (106.6 +/- 13.4) g/L vs. (103.5 +/- 12.3) g/L, P < 0.01], high hematocrit [Hct, (32.0 +/- 4.3)% vs. (31.0 +/- 4.0)%, P < 0.01], and high prevalence of CAL (23.8% vs. 16.8%, P < 0.05), respectively. The occurrence rate and emerging time of clinical manifestations in incomplete KD and in typical KD were presented, respectively: non-exudative conjunctivitis [occurrence rate, 64.9% vs. 93.5%; emerging time, (4.4 +/- 1.4) d vs. (4.0 +/- 1.6) d, respectively (P < 0.05 or P < 0.01)], erythema and cracking of lips [occurrence rate, 50.6% vs. 94.8%; emerging time, (4.9 +/- 1.4) d vs. (4.5 +/- 1.6) d, respectively (P < 0.05 or P < 0.01)], rash [occurrence rate, 35.1% vs. 87.7%; emerging time, (3.9 +/- 1.9) d vs. (3.4 +/- 1.7) d, respectively (P < 0.05 or P < 0.01)], erythema and edema of extremity [occurrence rate, 26.8% vs. 71.4%; emerging time, (6.7 +/- 1.5) d vs. (5.3 +/- 1.7) d, respectively (P < 0.01)], cervical lymphadenopathy [occurrence rate, 34.5% vs. 68.0%; emerging time, (4.3 +/- 2.5) d vs. (3.6 +/- 2.2) d, respectively (P < 0.05 or P < 0.01)], strawberry tongue [occurrence rate, 31.0% vs. 59.8%; emerging time, (5.6 +/- 2.2) d vs. (4.9 +/- 1.8) d, respectively (P < 0.05 or P < 0.01)], membranous desquamation of fingertips [occurrence rate, 34.5% vs. 56.3%; emerging time, (11.7 +/- 3.3) d vs. (10.3 +/- 2.7) d, respectively (P < 0.01)], and desquamation peri-anus [occurrence rate, 42.9% vs. 50.0%; emerging time, (6.7 +/- 2.7) d vs. (6.9 +/- 2.5) d, respectively (P > 0.05)]. Except for peri-anus desquamation, other clinical manifestations in incomplete KD were sporadical as compared to typical KD. (2) Six per cent (51/857) of cases were resistant to the IVIG therapy. As compared to the group responding to IVIG therapy, high prevalence of CAL (31.4% vs. 17.1%, P < 0.05), long fever duration [(10.6 +/- 3.9) d vs. (7.5 +/- 2.3) d, P < 0.01], low Hb level [(99.9 +/- 14.1) g/L vs. (104.3 +/- 12.4) g/L, P < 0.01], low Hct [(30.1 +/- 4.5)% vs. (31.2 +/- 4.0)%, P < 0.05], low platelet [PLT, (256.9 +/- 142.4) x 10(9)/L vs. (309.7 +/- 131.5) x 10(9)/L, P < 0.05], and low albumin level [ALB, (27.8 +/- 8.4) g/L vs. (33.5 +/- 6.7) g/L, P < 0.01] were found in the group resistant to IVIG therapy, respectively. (3) In patients who received IVIG 1 g/kg and 2 g/kg, the recovery rates from CAL were 83.1% and 89.7% (P > 0.05), respectively. The prevalence of CAL in those without CAL in acute and subacute stages was 0.9% and 3.5% (P > 0.05), respectively, during 2 year-follow-up period.

CONCLUSION

(1) Infants appeared to have more chances to suffer from incomplete KD. Incomplete KD had high prevalence of CAL. The peri-anus desquamation might be an important clue for early diagnosis of incomplete KD. (2) In acute stage, the influential factors for KD resistance to IVIG therapy included prolonged fever, non-elevated PLT, and persistent decrease in Hb, Hct and ALB levels. (3) Children receiving IVIG 1 g/kg and 2 g/kg had the similar effects on recovery and prevention from CAL within the first two years after KD onset.

Coronary Artery Dissection During Pregnancy Treated With Medical Therapy

Spontaneous coronary artery dissection is a rare etiology of myocardial infarction with a higher noted incidence in pregnancy. The recognition and proper treatment of this condition affects patient outcomes. We report the case of a coronary artery dissection during a twin pregnancy involving the left anterior descending artery. Successful treatment with medical management was possible once spontaneous reperfusion had been achieved.