Congenital giant aneurysm of the left coronary artery

Congenital Coronary Aneurysm: Unusual Presentation of Myocardial Ischemia in Children

Coronary artery aneurysms in children are usually associated with inflammatory disease such as Kawasaki disease or connective tissue disease. Congenital coronary aneurysm is a rare entity with few case reports published in the literature. We report an unusual case of congenital coronary aneurysm in an 11-year-old boy presented to our center with an ischemic cardiac event. Further investigations including computed tomography scan, cardiac magnetic resonance imaging, and coronary angiography revealed a large aneurysm arising from the proximal segment of left anterior descending (LAD) artery. Surgical repair was done including aneurysm resection and roofing the LAD artery using autologous saphenous vein patch.

Surgical Resection of a Giant Coronary Aneurysm

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.

Giant bypass aneurysm, a cause of suspected cardiac mass

Introduction

A 66-years old man suffering from coronary artery disease appeared without symptoms for routine follow-up in our clinic.

Case description

The echocardiogram revealed a tumorous mass of the right atrium and right ventricle. In the past, coronary revascularization with venous grafts of the right coronary artery and circumflex artery as well as internal mammaria graft to the left anterior descending artery was performed 20 years before. The general clinicians presented the case to the surgeons and it was decided to perform cardiac MRI as a preoperative diagnostic modality.

Discussion and evaluation

Following cardiac magnetic resonance imaging (MRI) showed a mass in the pericardium in the right atrioventricular groove with thrombotic material. Due to the MRI the patient underwent coronary angiography to confirm an aneurysm.

Conclusions

The learning points from this case are that cardiac MRI is a very useful tool for further evaluation of suspected cardiac masses and should be performed for further characterization.

Non-atherosclerotic multiple coronary artery aneurysms

A 52-year-old man underwent two-dimensional echocardiogram which showed moderate to severe aortic regurgitation (AR) and dilated ascending aorta. CT angiography (CTA) showed dilated ascending aorta (5 cm) and transoesophageal echocardiogram revealed bicuspid aortic valve. He underwent cardiac catheterisation which revealed triple vessel aneurysmal disease of the left anterior descending, left circumflex and right coronary artery. The patient underwent aortic graft placement for ascending aortic aneurysm and aortic valve replacement with a Saint Jude valve for severe AR. There was no history or stigmata of Kawasaki disease and workup for coronary artery aneurysm including vasculitis and connective tissue disorders was negative. Histopathology did not reveal evidence of active aortitis or dissection. His aneurysms are being observed by a yearly coronary CTA. We present a rare case of multiple coronary artery aneurysms associated with bicuspid aortic valve and ascending aortic aneurysm.

Surgical treatment for coronary artery aneurysm: a single-centre experience

OBJECTIVES

Coronary artery aneurysm is a rare condition with a reported incidence of 0.14-4.9% in patients undergoing coronary angiography and 0.3-5.3% in patients after percutaneous transluminal coronary angioplasty (PTCA). Optimum surgical therapy for this entity is difficult to standardize. We present here a series of 4 cases with the aim of establishing an optimal surgical therapy for this rare entity.

METHODS

Four cases of coronary artery aneurysm were admitted in the Department of Cardiology and Department of Cardiothoracic and Vascular Surgery, King George's Medical University, Lucknow, from April 2010 to April 2012. All patients underwent a surgical procedure that involved ligation and plication of the aneurysm with coronary artery bypass grafting.

RESULTS

Out of the four coronary artery aneurysm patients, 1 was atherosclerotic and the remaining 3 patients developed coronary artery aneurysm after PTCA with a drug eluting stent to the left anterior descending artery. After surgery, all patients recovered uneventfully without any recurrence of symptoms in the follow-up.

CONCLUSIONS

Coronary artery aneurysm is a rare entity and is being seen more frequently with the increasing use of stents during PTCA. Proximal ligation and plication of the aneurysm with coronary artery bypass grafting in the present series provided good results. With this case series, we seek to establish an optimal surgical therapy for this rare entity.

A case of giant coronary artery aneurysm with fistulous connection to the pulmonary artery: a case report and review of the literature

Giant coronary artery aneurysm is a rare condition with a reported prevalence of 0.02%. Herein, we report the case of a 79-year-old woman with 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 aneurysm was removed and inflow and outflow arteries were closed surgically. Histology showed prominent mucinous degeneration and infiltration of inflammatory cells in the medial layer. After successful surgery, the patient was discharged uneventfully.