Giant coronary artery aneurysm causing superior vena cava syndrome and congestive heart failure

A Giant Coronary Aneurysm in a Suspected Kawasaki Disease Causing Asymptomatic Myocardial Ischemia

Coronary involvement in Kawasaki disease is not uncommon; however, giant coronary aneurysm exceeding 50 mm is extremely rare. In this article, we presented a case of giant coronary aneurysm involving right coronary artery with associated asymptomatic myocardial ischemia as evident by multimodality imaging.

Giant coronary fistula aneurysm presenting as a progressing left-sided asymptomatic mediastinal mass with systolic dominant Doppler flow: a case report

Background

Cases of giant coronary artery aneurysms (GCAAs) associated with coronary fistula are rarely reported, and they present with various symptoms, including coronary steal syndrome. We report an uncommon case of an asymptomatic giant coronary fistula aneurysm presenting as a progressing left-sided mediastinal mass that has been tracked for years.

Case summary

A 67-year-old healthy asymptomatic woman was referred to our hospital because of an abnormal shadow on her chest radiography revealing a left-sided mediastinal mass that had progressed in size over the past 4 years. Computed tomography revealed mass progression from 4 to 5 cm in diameter within 2 years. Coronary computed tomography and coronary angiography identified a GCAAs in a coronary fistula originating in the left anterior descending artery and draining into the main pulmonary artery. Transthoracic Doppler echocardiography revealed a unique systolic dominant flow. She underwent coronary artery aneurysmectomy and fistula ligation. The patient has been in good health without any events for 10 months since her discharge.

Discussion

A GCAAs in a coronary fistula can present as an asymptomatic left-sided mediastinal mass that has progressed in size for years in older adults. Echocardiography can provide clues of the steal phenomenon in coronary artery fistula. A close investigation of mediastinal abnormalities can facilitate the detection of coronary aneurysms.

Giant Right Coronary Artery Aneurysm: A Case Report

Coronary artery aneurysms are not very uncommon but 'giant' coronary artery aneurysms are rare, with a reported prevalence of 0.02% to 0.2%. Coronary artery aneurysm may be symptomatic or asymptomatic depending on their size and location but it is very unusual for a giant coronary artery aneurysm to be asymptomatic. Here, we present a case in which the giant coronary artery aneurysm remained undiagnosed and asymptomatic for several years.

Superior vena cava syndrome secondary to recurrent coronary artery fistula: A case report and literature review

RATIONALE

Coronary artery fistula (CAF) is characterized by an abnormal communication of a coronary artery with a cardiac chamber or a great vessel bypassing the capillary bed. Surgical closure of large or symptomatic CAF is the gold standard treatment. However the previously closed CAF still has the possibility to reopen. Superior vena cava syndrome (SVCS) is defined as a condition that occurs when the obstruction of the superior vena cava interrupts blood flow from the head, upper extremities, and thorax to the right atrium and can present a life-threatening situation. In this report, we described a case of SVCS, which was secondary to the compression by a huge aneurysm formed in a recurrent CAF, as a long-term complication associated with surgical treatment of CAF.

PATIENT CONCERNS

A 47-year-old woman presented with chief complaint of progressive exertional dyspnea for one month.

DIAGNOSES

Superior vena cava syndrome and recurrent coronary artery fistula.

INTERVENTIONS

Reoperation for ligation of the fistulous and excision of the aneurysm were performed.

OUTCOMES

The patient made an uneventful recovery and her postoperative course through 1-year follow-up was uneventful.

LESSONS

First, SVCS is a rare but clinically important postoperative complication of surgical ligation of CAF. Second, surgical ligation of the fistula alone is unlikely to prevent the ectatic course. Therefore, long-term follow-up is mandatory for patients with CAF undergoing surgical closure.

Surgical treatment of coronary artery aneurysms

INTRODUCTION

Coronary artery aneurysms (CAA) are rare. We present our experience with the surgical treatment of patients with CAAs.

METHODS

Between March 2000 and October 2016, 15 patients with CAA underwent surgery.

RESULTS

Mean age of patients was 60 ± 16 years and 47% (n = 7) were male. Kawasaki syndrome was present in two (13%) patients and 7% (n = 1) patients had Marfan syndrome. Isolated CAAs were found in 73% (n = 11) and involvement of multiple vessels was present in 27% (n = 4) of patients. Coronary arteries (CA) affected by aneurysms were: 19% (n = 4) left main stem, 33% (n = 7) left anterior descending, 14% (n = 3) left circumflex, and 33% (n = 7) right coronary artery. The majority of patients (93%, n = 14) were operated on pump with a mean cross-clamp time of 51 ± 23 min. 53% (n = 8) of patients received total arterial CA bypass grafting, while the remaining patients (47%, n = 7) received venous ± internal thoracic artery grafts. Resection/ligation of CAA was performed in 27% (n = 4) of patients. In-hospital mortality was 0% (n = 0). Follow-up was complete for 100% of patients and comprised a total of 80 patient-years. During follow-up, only one patient (7%) required re-intervention.

CONCLUSION

Surgical treatment of CAA has good short- and long-term results.

Bilateral coronary artery fistulas with a giant coronary aneurysm complicated by aneurysm rupture: A case report

RATIONALE

Coronary artery aneurysms and fistulas are not rare conditions in clinical practice, but bilateral fistulas with a giant coronary aneurysm in just one person are quite rare.

PATIENT CONCERNS

We report a case of a 66-year-old woman with these 2 coronary abnormalities accompanied with a huge mediastinum mass.

INTERVENTIONS

The giant aneurysm was ligated and the mass was resected which was proved to be an organized hematoma finally.

OUTCOMES

The patient was discharged soon with no complications.

LESSONS

The best treatment of giant coronary aneurysm is not clear because of its rarity, surgical resection may be the right procedure for the potential serious complications like this case.

Giant left anterior descending artery aneurysm resulting in sudden death

Coronary artery aneurysm is a rare congenital or vascular inflammation-based anomaly for which the clinical course and optimal timing of treatment remain unclear. Here, we report a case of sudden death caused by a giant coronary artery aneurysm of the left anterior descending artery that presented with chest pain. This case suggests that urgent interventional or surgical repair is needed when a large coronary aneurysm presents with acute ischemic symptoms.

Giant coronary artery aneurysm with fistula to the pulmonary artery complicated by frequent ventricular premature contractions: a case report

Giant coronary artery aneurysm with a fistula is a rare condition. The presence of a giant aneurysm imposes considerable health risks. We report a case of a 67-year-old woman who presented with frequent ventricular premature contractions caused by a giant coronary aneurysm arising from a branch of the left anterior descending coronary artery that had a fistulous connection to the pulmonary artery. The patient was referred for cardiac surgery. The giant aneurysm was resected, and the proximal and distal openings were closed directly. The main pulmonary artery was opened longitudinally and the fistula was also closed directly. The patient's symptoms of frequent ventricular premature contractions disappeared postoperatively as confirmed by electrocardiography. Although the standard therapeutic strategies of the disease are not well established because of the rarity of this condition, our clinical results indicate that the surgical treatment is an effective choice.

Giant aneurysm of the right coronary artery and magnetic resonance coronary angiography

Coronary artery aneurysm (CAA) is generally defined as coronary dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. The prime cause of CAAs is atherosclerosis, and the most commonly affected artery is the right coronary artery. CAAs are quite commonly detected during X-ray coronary angiography. However, Coronary artery aneurysm (CAA) is generally defined as coronary dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. The prime cause of CAAs is atherosclerosis, and the most commonly affected artery is the right coronary artery. CAAs are quite commonly detected during X-ray coronary angiography. However, giant CAAs, especially with the diameter exceeding 100 mm, are extremely rare. The treatment method of choice of giant CAAs is the excision of aneurysm with coronary artery bypass grafting. We present a case of a 41-year-old apparently healthy woman with a giant right CAA. This was detected by noninvasive methods, including magnetic resonance coronary angiography, and its maximum diameter exceeded 100 mm. In emergency, the aneurysmal sac was excised and the aortocoronary saphenous vein graft was performed. We also present a review of the published studies of giant CAAs with the diameter exceeding 100 mm.

Off-pump surgery for giant right coronary artery aneurysms

Coronary artery aneurysms larger than 5 cm are exceedingly rare, and a standard treatment for them is lacking. We report two cases of giant right coronary artery aneurysms successfully treated by off-pump resection of the aneurysm and bypass grafting. The controversy surrounding the proper management of such cases is discussed.

Giant aneurysm of an aortocoronary venous bypass graft compressing the right ventricle

A 69-year-old man with a history of coronary artery bypass grafting and a recent inferoposterior myocardial infarction presented to the hospital for diagnostic coronary angiography. Physical examination, laboratory analyses, coronary angiography, echocardiography, and CT scan were performed. A giant aneurysm of the aortocoronary venous bypass graft, associated with compression of the right side of the heart, was revealed. After surgical resection and replacement of the venous graft the patient died due to right ventricular failure. (Neth Heart J 2007;15:252-4.Neth Heart J 2007;15:252-4.).

Position dependent right ventricular dysfunction caused by a giant right coronary artery aneurysm

We describe an instructive case of a 79-year-old patient with a giant coronary aneurysm and a second smaller aneurysm with an uncommon symptomatology. Giant coronary artery aneurysms (>2 cm diameter) are rare pathologic entities with a prevalence of 0.02%. They either can be congenital malformations or are atherosclerotic in origin. Although spontaneous rupture of giant coronary artery aneurysms has been reported, they generally remain silent or induce myocardial ischemia. Our patient, however, showed no signs of myocardial malperfusion but transient position-dependent pre-syncope. The cardiologic work-up and the intraoperative considerations regarding patient management are described. During surgery, manipulation of the giant coronary artery aneurysm caused impairment of right ventricular function and regional wall hypokinesia, as assessed by transesophageal echocardiography. Venous cannulation of the right atrium was thus abandoned and extracorporeal circulation was established via the femoral vein. Subsequent dissection and surgical repair were uneventful and further recovery of the elderly patient was uncomplicated. This case underlines that once the diagnosis is established, proper perioperative management enables successful surgical treatment even of patients of advanced age.

A case of giant coronary artery aneurysm and literature review

A 40-year-old man was referred to our hospital because of an abnormal shadow on the left cardiac border on the chest roentgenogram at the regular medical health examination without any symptoms. A giant coronary artery aneurysm of left anterior descending artery with a maximum diameter of approximately 50 mm was detected with computed tomography and coronary angiography. The patient was treated and followed up medically. Four years later, the size of the coronary artery aneurysm became larger. Then resection of the coronary artery aneurysm and coronary artery bypass grafting were successfully performed. Coronary artery aneurysms are rare in adults and are usually found in association with Kawasaki disease, coronary atherosclerosis, and so on. We also review the literature of giant coronary artery aneurysms exceeding 50 mm in diameter.

Clinical and angiographic features of large left main coronary artery aneurysms

Coronary artery aneurysms are defined as coronary dilatations which exceed the diameter of normal adjacent segments by 1.5 times. Left main coronary artery (LMCA) is the least frequently involved artery with a prevalence of 0.1%. Majority of coronary artery aneurysms are atherosclerotic in origin. Their size and clinical presentation is variable. A number of complications have been reported to occur during the course of the disease including thrombosis and distal embolization, myocardial ischemia and/or infarction, dissection, vasospasm, calcification, fistulization and very rarely rupture. Large aneurysms of LMCA represent a potentially fatal condition even without concomitant atherosclerotic coronary disease. Because of rarity of coronary artery aneurysms, it is difficult to standardize treatment. In this article, we presented 4 cases of large LMCA aneurysms with various clinical and angiographic features.

Giant right coronary artery aneurysm presenting as a paracardiac mass

Coronary artery aneurysms, commonly atherosclerotic, are usually asymptomatic and can be diagnosed incidentally during investigation for ischemic heart disease or on autopsy. An asymptomatic giant right coronary artery aneurysm presenting as a paracardiac mass discovered on autopsy is reported here. Even though there was great concern due to its large size, complex atherosclerotic lesions, and potential obstruction of blood flow, it had no direct link to the cause of death. We also review the literature on giant right coronary artery aneurysms exceeding 5 cm in the last 10 years.