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Higashino A, Taketani T, Suzuki H, Miura S, Ohno T. A Giant Left Coronary Button Aneurysm After Aortic Root Remodeling Procedure in a Patient With Marfan Syndrome: A Case Report. Cureus 2022; 14:e26031. [PMID: 35865442 PMCID: PMC9293275 DOI: 10.7759/cureus.26031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/05/2022] Open
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A rare case: A giant right coronary artery aneurysm mimicking a paracardiac mass. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.848828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yoshimura K, Tanaka H, Wada T, Shuto T, Kawano M, Anai H, Miyamoto S. True Aneurysm of the Left Main Trunk in a Marfan Syndrome Patient at Remote Period after Bentall Operation and Total Arch Replacement: A Case Report. Ann Thorac Cardiovasc Surg 2019; 27:327-331. [PMID: 31068502 PMCID: PMC8560535 DOI: 10.5761/atcs.cr.18-00081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2002, a 37-year-old male with Marfan syndrome underwent the Bentall operation, total arch replacement, and aortobifemoral bypass for DeBakey type IIIb chronic aortic dissection, annuloaortic ectasia, and aortic regurgitation. In 2007, mild mitral regurgitation (MR) caused by mitral valve prolapse was identified. In April 2017, echocardiography revealed the worsening of MR and moderate tricuspid regurgitation (TR). Moreover, coronary angiography (CAG) revealed a coronary artery aneurysm in the left main trunk (LMT). In August 2017, the patient underwent mitral valve replacement (MVR), tricuspid annuloplasty (TAP), and coronary artery reconstruction. We reconstructed the LMT aneurysm using an artificial graft. True aneurysm of the coronary artery complicated with Marfan syndrome is a rare complication that has seldom been reported. This case highlights that it is essential to carefully follow-up patients with Marfan syndrome after the Bentall operation.
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Affiliation(s)
- Kenshi Yoshimura
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Hideyuki Tanaka
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Tomoyuki Wada
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Takashi Shuto
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Madoka Kawano
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Hirofumi Anai
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
| | - Shinji Miyamoto
- Department of Cardiovascular Surgery, Oita University Hospital, Yufu, Oita, Japan
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Hołda MK, Iwaszczuk P, Wszołek K, Chmiel J, Brzychczy A, Trystuła M, Misztal M. Coexistence and management of abdominal aortic aneurysm and coronary artery disease. Cardiol J 2018; 27:384-393. [PMID: 30234902 DOI: 10.5603/cj.a2018.0101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/07/2018] [Accepted: 07/23/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) and coronary atherosclerosis share common risk factors. In this study, a single-center management experience of patients with a coexistence of AAA and coronary artery disease (CAD) is presented. METHODS 271 consecutive patients who underwent elective AAA repair were reviewed. Coronary imaging in 118 patients was considered suitable for exploration of AAA coexistence with CAD. RESULTS Significant coronary stenosis (> 70%) were found in 65.3% of patients. History of cardiac revascularization was present in 26.3% of patients, myocardial infarction (MI) in 31.4%, and 39.8% had both. In a subgroup analysis, prior history of percutaneous coronary intervention (PCI) (OR = 6.9, 95% CI 2.6-18.2, p < 0.001) and patients' age (OR = 1.1, 95% CI 1.0-1.2, p = 0.007) were independent predictors of significant coronary stenosis. Only 52.0% (40/77) of patients with significant coronary stenosis underwent immediate coronary revascularization prior to aneurysm repair: PCI in 32 cases (4 drug-eluting stents and 27 bare metal stents), coronary artery bypass graft in 8 cases. Patients undergoing revascularization prior to surgery had longer mean time from coronary imaging to AAA repair (123.6 vs. 58.1 days, p < 0.001). Patients undergoing coronary artery evaluation prior to AAA repair had shorter median hospitalization (7 [2-70] vs. 7 [3-181] days, p = 0.007) and intensive care unit stay (1 [0-9] vs. 1 [0-70] days, p = 0.014) and also had a lower rate of major adverse cardiovascular events or multiple organ failure (0% vs. 3.9%, p = 0.035). A total of 11.0% of patients had coronary artery aneurysms. CONCLUSIONS Patients with AAA might benefit from an early coronary artery evaluation strategy.
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Affiliation(s)
- Mateusz K Hołda
- Department of Anatomy, Faculty of Medicine, Jagiellonian University Medical College.
| | - Paweł Iwaszczuk
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Karolina Wszołek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Chmiel
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Brzychczy
- Department of Vascular Surgery and Endovascular Procedures, John Paul II Hospital, Kraków, Poland
| | - Mariusz Trystuła
- Department of Vascular Surgery and Endovascular Procedures, John Paul II Hospital, Kraków, Poland
| | - Marcin Misztal
- Department of Vascular Surgery and Endovascular Procedures, John Paul II Hospital, Kraków, Poland
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Multiple Giant Coronary Artery Aneurysms Surgically Treated with Bypass Grafting: A Challenging Rarity. Case Rep Surg 2018; 2018:2096902. [PMID: 30228924 PMCID: PMC6136512 DOI: 10.1155/2018/2096902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/15/2018] [Accepted: 07/22/2018] [Indexed: 01/08/2023] Open
Abstract
Coronary artery aneurysms are encountered in daily cardiology practise but multiple giant-sized coronary artery aneurysms are extremely rare. We present an illustrative case of multiple giant aneurysms located throughout the coronary system (left main stem and all left, right, and circumflex branches) in a 57-year-old male with acute coronary syndrome. The case was managed successfully with on-pump quadruple coronary artery bypass grafting. To our knowledge, few cases of multiple giant aneurysms in all coronary vessels have been reported.
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Jeudy J, White CS, Kligerman SJ, Killam JL, Burke AP, Sechrist JW, Shah AB, Hossain R, Frazier AA. Spectrum of Coronary Artery Aneurysms: From the Radiologic Pathology Archives. Radiographics 2018; 38:11-36. [DOI: 10.1148/rg.2018170175] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Jiang LC, Cao JY, Chen M. Coronary artery aneurysm combined with other multiple aneurysms at multiple locations: A case report and systematic review. Medicine (Baltimore) 2017; 96:e9230. [PMID: 29390352 PMCID: PMC5815764 DOI: 10.1097/md.0000000000009230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Coronary artery aneurysm (CAA) with concomitant aneurysms at multiple sites is quite unusual and rare. The characteristics and the etiology of this phenomenon are unknown. METHODS Herein, we present a case with right coronary aneurysm with concomitant abdominal aorta as well as right renal artery aneurysm. A systematic review of the literatures regarding CAA with other coexisting aneurysms at multiple locations was also conducted on Medline and Embase databases. RESULTS A total of 76 patients (male gender: 58; age: 37.4 ± 26.5) including the present case were included in the final study. The most common etiology of CAA with multiple aneurysms was Kawasaki (43.3%) and atherosclerotic disease (16.4%). CAA was the most frequently found at the right coronary artery (62.7%), following, left anterior descending (51%), left main (43.1%), and left circumflex (35.3%). The most common concomitant aneurysms were abdominal aorta (52.6%) and iliac artery (50%). In addition, 60.5% of the patients had an involved bilateral peripheral artery. CONCLUSION CAA with coexisting systemic aneurysms in multiple sites is quite rare. And it usually involves multiple aneurysms at the coronary and bilateral peripheral arteries simultaneously. Currently, there are no general consensus regarding the clinical characteristics, diagnostic method, and treatment of these cases.
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Janík M, Hejna P, Ublová M, Šteiner I. Multiple Giant Coronary Artery Aneurysms: A Rare Cause of Sudden Cardiac Death. J Forensic Sci 2016; 62:515-518. [PMID: 27859306 DOI: 10.1111/1556-4029.13264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/06/2016] [Accepted: 05/15/2016] [Indexed: 11/29/2022]
Abstract
Multiple giant aneurysms involving the coronary arteries are uncommon and rarely reported. In the presented case, a 63-year-old man with poorly controlled hypertension died suddenly. Gross autopsy examination showed multiple giant thrombus-filled coronary artery aneurysms, atherosclerotic coronary artery disease, and cardiomegaly. Histological sections of the coronary aneurysms showed atherosclerotic changes with both organized and fresh thrombus. Giant coronary aneurysm is defined as a segmental enlargement of a coronary artery with a diameter exceeding 20 mm or more. The main etiology of this nebulous entity is attributed to atherosclerosis and inflammatory or inherited connective tissue disorders with the remainder being congenital, infectious, or idiopathic. Before its cataclysmic presentation, when ruptured or thrombosed, giant coronary aneurysm usually has a silent clinical course. Sudden death owing to giant multiple coronary aneurysms is rare and mandates careful classification of the aneurysms and prudent search for autoimmune-mediated or genetically based factors for subsequent ancillary autopsy studies.
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Affiliation(s)
- Martin Janík
- Department of Forensic Medicine and Medicolegal Expertises, Jessenius Faculty of Medicine, Comenius University, University Hospital, Martin, Slovak Republic
| | - Petr Hejna
- Department of Forensic Medicine, Faculty of Medicine, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Michaela Ublová
- Department of Forensic Medicine, Faculty of Medicine, Charles University and University Hospital, Hradec Kralove, Czech Republic
| | - Ivo Šteiner
- The Fingerland Department of Pathology, Faculty of Medicine, Charles University and University Hospital, Hradec Kralove, Czech Republic
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Large coronary aneurysm may indicate concomitant asymptomatic huge thoracic aortic aneurysm. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2016. [DOI: 10.1016/j.ijcac.2016.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mehall JR, Verlare JL. Surgical Resection of a Giant Coronary Aneurysm. Ann Thorac Surg 2015; 99:2212-3. [PMID: 26046882 DOI: 10.1016/j.athoracsur.2014.07.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/26/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022]
Abstract
Coronary aneurysms are quite uncommon, and those qualifying as giant aneurysms are even more so. Currently, no standardized treatment protocol exists. We report the case of a 46-year-old man presenting with clinical signs and symptoms of acute myocardial infarction who was found to have a giant coronary aneurysm. The patient was initially evaluated with a computed tomography angiogram, which revealed a 9-cm aneurysm of the left circumflex coronary artery. Surgical resection of the aneurysm, ligation of the proximal circumflex artery, and bypass using the left internal mammary artery to vascularize the proximal circumflex artery was performed.
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Affiliation(s)
- John R Mehall
- Cardiac and Thoracic Surgery Associates, Colorado Springs, Colorado.
| | - Jordan L Verlare
- Cardiac and Thoracic Surgery Associates, Colorado Springs, Colorado
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Moazzam AA, Savvas SN, Amar AP, Ham SW, Panush RS, Clavijo LC. Diffuse aneurysmal disease – A review. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rvm.2013.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Solodkyy A, Shalhoub J, Chetty G, Briffa NP. A rare case of giant coronary artery aneurysm in the context of multiple arterial aneurysms. Int J Surg Case Rep 2012; 3:311-3. [PMID: 22543232 DOI: 10.1016/j.ijscr.2012.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 03/24/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Whilst the incidence of CAA has been reported as up to 5%, giant CAA (>2cm) is rare. PRESENTATION OF CASE We present a rare case of 3cm×4cm giant coronary artery aneurysm (CAA) in the context of aorto-iliac aneurysmal disease, treated by staged open surgical repair. DISCUSSION Abdominal aortic aneurysm (AAA) and CAA share risk factors and aetiological mechanisms, therefore should be considered, particularly when CAA is diagnosed in the first instance. CONCLUSIONS Surgical intervention for diagnosed giant CAA appears to be the treatment of choice in the reported literature, with the order of intervention when AAA co-exists remaining a point for debate.
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Affiliation(s)
- Andriy Solodkyy
- Department of Cardiothoracic Surgery, Northern General Hospital, Herries Road, Sheffield, UK; Department of Vascular Surgery, Northwick Park Hospital, Watford Road, Harrow, Middlesex, UK
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Rodríguez JC, Rivera A, Pinzón B. Aneurisma del tronco principal de la arteria coronaria izquierda Descripción de un caso clínico y revisión de tema. REVISTA COLOMBIANA DE CARDIOLOGÍA 2010. [DOI: 10.1016/s0120-5633(10)70230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Badger SA, O'Donnell ME, Sharif MA, Boyd CS, Soong CV. Advantages and pitfalls of abdominal aortic aneurysm screening in high-risk patients. Vascular 2008; 16:201-6. [PMID: 18845100 DOI: 10.2310/6670.2008.00042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Screening for abdominal aortic aneurysm (AAA) has been suggested for older men. Our aim was to determine the effect of participant selection on prevalence and treatment suitability. Men aged 65 to 75 years attending cardiology clinics composed the high-risk group; the control group was from the community. AAA screening was performed, with follow-up or surgery arranged. Four hundred eight of 651 (62.7%) high-risk men and 109 of 908 (45.0%; p< .0001) men attended from the community. In the high-risk patients, 40 AAAs were diagnosed, with a mean diameter of 41.4 mm (+/-10.4 mm). In the control group, 22 new AAAs were found, with an average size of 40.9 mm (+/-10.4 mm). Higher polypharmacy existed in the high-risk group (4.6+/-2.2 vs 2.3+/-2.0; p< .0001). More aneurysm patients were on dual-antiplatelet therapy (32.5% vs 15.4%; p= .048) compared with the overall high-risk group. In this group, three underwent surgery; one was anatomically unsuitable for endovascular repair and medically unfit for open repair. Two in the control group had surgery. A higher prevalence of AAA is encountered in high-risk men. Most aneurysms are small; however, a significant proportion of the aneurysms detected were of a size that would warrant repair. The decision to perform surgical repair is likely to be influenced by the comorbid medical conditions, which placed the patients in the high-risk category.
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Affiliation(s)
- Stephen A Badger
- Vascular and Endovascular Surgery Center, Belfast City Hospital, Belfast, Northern Ireland.
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Nichols L, Lagana S, Parwani A. Coronary artery aneurysm: a review and hypothesis regarding etiology. Arch Pathol Lab Med 2008; 132:823-8. [PMID: 18466032 DOI: 10.5858/2008-132-823-caaara] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2007] [Indexed: 12/16/2022]
Abstract
CONTEXT Coronary artery aneurysm is an uncommon condition that can be a cause of death when it thromboses or ruptures. It is always associated with destruction of the tunica media, usually associated with atherosclerosis, and commonly associated with chronic inflammation. OBJECTIVE To review the pathology, epidemiologic and clinical features, and pathophysiology of coronary artery aneurysm, particularly new research results, drawing out implications for the understanding, diagnosis, and treatment of this condition. DATA SOURCES Pertinent literature and illustrative cases at our institution. CONCLUSIONS Inflammation spilling over into the tunica media from the tunica intima may link atherosclerosis to aneurysm formation, but vasculitis without atherosclerosis causes coronary artery aneurysms in young children with Kawasaki disease. Increased proteolysis of extracellular matrix proteins is probably one mechanism of coronary artery aneurysm formation, either due to overactive matrix metalloproteinases or underactive inhibition of these proteinases, and an excess of transforming growth factor beta may be another mechanism in the pathogenesis. Coronary atherosclerosis is a universal disease of adults, but only 1.5% of them have coronary aneurysms; this small group may be those with a second coronary artery disease, such as vasculitis.
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Affiliation(s)
- Larry Nichols
- Department of Pathology, University of Pittsburgh Medical Center, A610 Scaife Hall, 200 Lothrop St, Pittsburgh, PA 15213-2582, USA.
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Mariscalco G, Sessa F, Vanoli D, Mantovani V, Sandro F, Sala A. Transthoracic echocardiography is adequate for the diagnosis of right coronary artery aneurysms. J Card Surg 2008; 23:72-4. [PMID: 18290896 DOI: 10.1111/j.1540-8191.2007.00500.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Coronary artery aneurysms (CAA) are rare but potentially fatal pathologies. This case was referred to our Unit after occasional echocardiographic finding of an intracardiac mass. A new detailed transthoracic echocardiogram was decisive for a diagnosis of a large CAA of the right coronary artery, compressing and dislocating the right atrium. Transesophageal echocardiography was not performed because of the data obtained. The diagnosis was confirmed by cardiac catheterization. The patient was managed with a surgical procedure.
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Affiliation(s)
- Giovanni Mariscalco
- Department of Surgical Sciences, Cardiac Surgery Division, Varese University Hospital, Italy.
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Haddad F, Perez M, Fleischmann D, Valantine H, Hunt SA. Giant Coronary Aneurysms in Heart Transplantation: an Unusual Presentation of Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2006; 25:1367-70. [DOI: 10.1016/j.healun.2006.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Revised: 06/22/2006] [Accepted: 07/17/2006] [Indexed: 10/24/2022] Open
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