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Rutherford A, Chandrasekaran B, Petrou M, Ramcharitar S. Giant proximal left anterior descending aneurysm causing multi-vessel myocardial ischaemia: the pressure is on-a case report. Eur Heart J Case Rep 2023; 7:ytad550. [PMID: 38025138 PMCID: PMC10665038 DOI: 10.1093/ehjcr/ytad550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 09/20/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
Background Giant coronary artery aneurysms are a rare cause of myocardial ischaemia. Due to the rarity and variety of presentation of these cases, no standardized investigation or treatment has been established for management. We report a case study of a giant proximal left anterior descending (LAD) coronary aneurysm causing myocardial ischaemia due to the pressure effect from the weight of the aneurysm as well as from a change in rheology from a 'steal effect' on both the LAD and left circumflex (LCx) arteries. Case summary A 55-year-old patient presents initially with a history of angina. Initial investigation with computed tomography (CT) was suboptimal, requiring invasive diagnostic angiography, which detects a giant proximal LAD aneurysm. Subsequent investigations, with CT-fractional flow reserve (FFR) and stress echocardiography (ECHO), correlated to identify multi-vessel ischaemia resulting from the aneurysm. The patient was managed with multi-disciplinary team-led surgical resection and triple coronary artery bypass grafts with good results. Discussion This case highlights the complexity of coronary anomalies and importance of additional functional three-dimensional imaging on top of the static computational tomography coronary angiography analysis. Together, these two complimentary investigations qualitatively enabled the assessment of anomaly with surrounding structures such that the possibility of a mass effect on the LCx artery results in a positive stress test. Furthermore, this is a novel use of CT-FFR for coronary anomalies and it demonstrated good correlation of LAD territory ischaemia between CT-FFR and the stress ECHO.
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Affiliation(s)
| | | | - Mario Petrou
- Royal Brompton and Harefield Hospitals, Sydney Street, London SW3 6NP, UK
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2
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Singhal M, Pilania RK, Gupta P, Johnson N, Singh S. Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease. World J Clin Pediatr 2023; 12:97-106. [PMID: 37342454 PMCID: PMC10278081 DOI: 10.5409/wjcp.v12.i3.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
Coronary artery abnormalities are the most important complications in children with Kawasaki disease (KD). Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD. However, it has inherent limitations with regard to evaluation of mid and distal coronary arteries and, left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group. Catheter angiography (CA) is invasive, has high radiation exposure and fails to demonstrate abnormalities beyond lumen. The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems. In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children. Computed tomography coronary angiography (CTCA) can be performed during acute as well as convalescent phases of KD. It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.
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Affiliation(s)
- Manphool Singhal
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Rakesh Kumar Pilania
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Pankaj Gupta
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Nameirakpam Johnson
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India
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3
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Taguchi H, Obase K, Eishi J, Nakaji S, Miura T, Eishi K. Surgery for posterior wall rupture of a left main trunk coronary artery aneurysm. JTCVS Tech 2022; 16:96-98. [PMID: 36510524 PMCID: PMC9735325 DOI: 10.1016/j.xjtc.2022.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
| | | | | | | | - Takashi Miura
- Address for reprints: Takashi Miura, MD, PhD, Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-City 852-8501, Japan
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4
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Elsadany M, Selter J, Mattana J. An Incidentally Discovered Large Left Main Coronary Artery Aneurysm. Cureus 2020; 12:e9172. [PMID: 32802608 PMCID: PMC7423498 DOI: 10.7759/cureus.9172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Hua A, Garbi M, Sado D, Rajani R, Albarjas M. Nowhere to Hide. Circ Cardiovasc Imaging 2020; 13:e009643. [DOI: 10.1161/circimaging.119.009643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alina Hua
- Department of Cardiology, Princess Royal University Hospital, Orpington, United Kingdom (A.H., M.G., M.A.)
| | - Madalina Garbi
- Department of Cardiology, Princess Royal University Hospital, Orpington, United Kingdom (A.H., M.G., M.A.)
| | - Daniel Sado
- Department of Cardiology, King’s College Hospital, London, United Kingdom (D.S.)
| | - Ronak Rajani
- Department of Cardiology, St. Thomas’ Hospital, London, United Kingdom (R.R.)
| | - Mohammad Albarjas
- Department of Cardiology, Princess Royal University Hospital, Orpington, United Kingdom (A.H., M.G., M.A.)
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6
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Singhal M, Gupta P, Sharma A. Imaging in small and medium vessel vasculitis. Int J Rheum Dis 2019; 22 Suppl 1:78-85. [DOI: 10.1111/1756-185x.13390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/22/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Manphool Singhal
- Department of Radiodiagnosis and Imaging; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Aman Sharma
- Department of Internal Medicine; Postgraduate Institute of Medical Education and Research; Chandigarh India
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Hsu CY, Chana R, Ayoub C, Schoenhagen P, Roselli EE, Pettersson GB, Bakaeen FG. Surgical repair of a left main coronary artery aneurysm. J Card Surg 2018; 33:634-637. [PMID: 30221393 DOI: 10.1111/jocs.13819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report the repair of a 6.5 × 5.3-cm left main coronary artery aneurysm by marsupialization of the aneurysm sac and coronary artery bypass grafting.
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Affiliation(s)
- Chan-Yang Hsu
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rajdeep Chana
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Forte E, Aiello M, Inglese M, Infante T, Soricelli A, Tedeschi C, Salvatore M, Cavaliere C. Coronary artery aneurysms detected by computed tomography coronary angiography. Eur Heart J Cardiovasc Imaging 2018; 18:1229-1235. [PMID: 28025267 DOI: 10.1093/ehjci/jew218] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/25/2016] [Indexed: 01/11/2023] Open
Abstract
Aims Coronary artery aneurysms (CAAs) are incidentally revealed by coronary angiography and consist in a localized dilation of a coronary artery. Although invasive coronary angiography (ICA) is the gold standard imaging technique, it can lead to the underestimation of CAAs diameter in presence of parietal thrombi. Computed tomography coronary angiography (CTCA) is a very sensitive tool in CAAs detection and provides a clear visualization of coronary lumen highlighting intraluminal thrombi. Methods and results We retrospectively reviewed 390 CTCA performed at our institution, 9 patients (6 men, 3 women) resulted affected by CAAs and represented the aneurysmal group (A group). Matched controls were identified among the non-aneurysmal patients with healthy coronaries to CTCA (NAH group). Clinical variables and imaging findings were compared and correlated. CAAs prevalence in our population was 2.31%. 15 CAAs were detected, mainly on the right coronary artery (RCA) (9 aneurysms) followed by the left anterior descending coronary artery (LAD) (three aneurysms) and the left circumflex coronary artery (CX) (three aneurysms). In six patients (66.7%) CTCA displayed an aneurysmal thrombosis and in 5 patients (55.5%) CAAs were associated to coronary artery stenoses. A statistically significant difference was found between the diameters of coronary vessels measured in healthy segments in A and NAH group. Conclusions CTCA has led to a non-invasive estimation of CAAs prevalence and characterization of aneurysmal features and coronary anatomy. Overcoming ICA limitations, CTCA has provided a fine analysis of the aneurysms, also in presence of intraluminal thrombi.
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Affiliation(s)
- Ernesto Forte
- IRCCS SDN, Via E. Gianturco 113, 80143 Naples, Italy
| | - Marco Aiello
- IRCCS SDN, Via E. Gianturco 113, 80143 Naples, Italy
| | | | | | | | - Carlo Tedeschi
- Unit of Cardiology, San Gennaro Hospital, ASL Napoli 1 Centro, Via San Gennaro 25, 80100 Naples, Italy
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Lage IB, Bastarrika G, Domínguez CD, Alonso PP, Juan-Aracil GR. Large left main coronary artery aneurysm following mitral and aortic valve replacement. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-017-0568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Singhal M, Gupta P, Singh S, Khandelwal N. Computed tomography coronary angiography is the way forward for evaluation of children with Kawasaki disease. Glob Cardiol Sci Pract 2017; 2017:e201728. [PMID: 29564349 PMCID: PMC5856970 DOI: 10.21542/gcsp.2017.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease (KD) is an acute idiopathic vasculitis affecting infants and children. Coronary artery abnormalities and myocarditis are the major cardiovascular complications of KD. Coronary artery abnormalities develop in 15–25% of untreated KD. Two-dimensional transthoracic echocardiography has hitherto been considered the modality of choice for evaluation of children with KD. There are, however, several limitations inherent to echocardiography - including limited evaluation of distal vessels, left circumflex artery and poor acoustic window in growing children. Catheter angiography is the gold standard for evaluation of coronary artery abnormalities in older children and adults; however it also has inherent limitations - including complications related to its invasive nature, higher radiation exposure, and inability to evaluate intramural abnormalities. Thus serial invasive coronary angiography studies are not feasible in children. There have been major advances in computed tomography (CT) coronary imaging so that it is now possible to delineate the coronary artery anatomy with higher temporal resolution and motion-free images at all heart rates with acceptable radiation exposure. There is, however, a paucity of literature with regard to the use of this technique in children with KD. In this review, we discuss the application of computed tomography coronary angiography (CTCA) in children with KD with special reference to strategies aimed at reducing the effective radiation dose.
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Affiliation(s)
- Manphool Singhal
- Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, INDIA-160012
| | - Pankaj Gupta
- Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, INDIA-160012
| | - Surjit Singh
- Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, INDIA-160012
| | - Niranjan Khandelwal
- Advanced Pediatrics Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, INDIA-160012
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Singhal M, Singh S, Gupta P, Sharma A, Khandelwal N, Burns JC. Computed Tomography Coronary Angiography for Evaluation of Children With Kawasaki Disease. Curr Probl Diagn Radiol 2017; 47:238-244. [PMID: 29203262 DOI: 10.1067/j.cpradiol.2017.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We sought to assess the feasibility of computed tomography coronary angiography (CTCA) on a 128-slice, dual source scanner in children with acute and convalescent phase Kawasaki disease (KD). MATERIALS AND METHODS A prospective study of 49 children with KD (12 at presentation and 37 in the convalescent phase) was conducted between November 2013 and April 2015. CTCA was performed with either prospective (n = 37) or retrospective (n = 12) electrocardiographic gating. A radiologist blinded to clinical profile and echocardiogram evaluated each scan. RESULTS Median age (36 boys and 13 girls) was 7 years. Median dose-length product value and median effective CT radiation dose was 32mGycm (interquartile range [IQR]: 21-74) and 0.54 miliSieverts (mSv) (IQR: 0.77-3.2) for all scans, and 27mGycm (IQR: 18.5-33.75) and 0.48mSv (IQR: 0.18-1.17) for prospectively triggered scans (n = 37). Fourteen subjects (30 coronary segments) showed abnormalities by CTCA including aneurysms (n = 27) and stenoses (n = 3). In the acute phase (n = 12), aneurysms were detected in 5 children (18 segments). CONCLUSION CTCA allows comprehensive evaluation of coronary arteries in children with KD.
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Affiliation(s)
- Manphool Singhal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Surjit Singh
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Avinash Sharma
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego (UCSD) School of Medicine and Rady Children's Hospital San Diego, La Jolla, CA
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12
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Kawase Y, Ishii Y, Yoshio T, Nishina D, Bessho R, Nitta T. Three Year Follow-Up of a Vein Patch Repair for a Coronary Artery Saccular Aneurysm of the Left Main Bifurcation. Ann Thorac Cardiovasc Surg 2017; 23:104-107. [PMID: 27431924 DOI: 10.5761/atcs.cr.16-00064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This report describes a case of surgical treatment for a coronary artery saccular aneurysm of the left main bifurcation. A coronary artery saccular aneurysm (7 mm × 10 mm) and three vessel disease, including the left main trunk, were diagnosed by coronary angiography. A surgical resection and saphenous vein patch repair of the left main coronary artery aneurysm was performed concomitantly with coronary artery bypass grafting. The pathological findings of the aneurysm clarified that the aneurysm wall was atrophic and extremely thin because of a collapsed trilaminar arterial structure due to atherosclerosis. A coronary computed tomographic scan revealed no aneurysmal formation in the patent left main trunk and patent grafts 3 years after surgery.
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Affiliation(s)
- Yasuhiro Kawase
- Cardiovascular Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Yosuke Ishii
- Cardiovascular Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Takahide Yoshio
- Cardiovascular Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Dai Nishina
- Cardiovascular Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Ryuzo Bessho
- Cardiovascular Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan
| | - Takashi Nitta
- Cardiovascular Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Lee CH, Son CW, Park JS. Giant left anterior descending artery aneurysm resulting in sudden death. Hellenic J Cardiol 2016; 57:S1109-9666(16)30148-8. [PMID: 27666752 DOI: 10.1016/j.hjc.2015.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 05/28/2015] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Chan-Hee Lee
- Department of Cardiology, Yeungnam University Hospital, Daegu, South Korea
| | - Chang-Woo Son
- Department of Cardiology, Andong Sungso Hospital, Andong, South Korea
| | - Jong-Seon Park
- Department of Cardiology, Yeungnam University Hospital, Daegu, South Korea.
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Wang L, Wang J, Cheng TO, Xie M, Wang X, Song Y, Liu J, Wei F. Giant left coronary artery aneurysms: Review of the literature and report of a rare case diagnosed by transthoracic echocardiography. Int J Cardiol 2015; 189:267-71. [DOI: 10.1016/j.ijcard.2015.04.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Dolichoectasia (DE) in cerebral arteries is a poorly understood arteriopathy that has been associated with increased risk of vascular morbidity and mortality. Dolichoectasia tends to affects older individuals with vascular risk factors, but it can also be secondary to specific conditions related with extracellular matrix health. The range of methods used to study DE and the biases inherent to hospital-based samples weaken the generalizability of DE study results to the general population. Within the context of these limitations, there is growing evidence that DE is a serious condition that can increase the risk of vascular death. Recurrent strokes and compressive symptoms are among the major causes of morbidity, but cardiac ischemic disease and aortic aneurysms are not uncommon in populations with DE. The devastating outcomes of patients with DE are a call to action aimed at improving the quality of research on the topic and discovering therapies that can palliate the burden of DE in the population.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Columbia University Medical Center, 710 W 168th Street, 6th floor, Suite 639, New York, NY, 10032, USA,
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16
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An unexpected echocardiographic finding in a patient with non-ST segment elevation myocardial infarction. Eur Geriatr Med 2011. [DOI: 10.1016/j.eurger.2011.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Position dependent right ventricular dysfunction caused by a giant right coronary artery aneurysm. Wien Klin Wochenschr 2011; 123:58-60. [PMID: 21253776 DOI: 10.1007/s00508-010-1516-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
Abstract
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.
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Díaz-Zamudio M, Bacilio-Pérez U, Herrera-Zarza MC, Meave-González A, Alexanderson-Rosas E, Zambrana-Balta GF, Kimura-Hayama ET. Coronary artery aneurysms and ectasia: role of coronary CT angiography. Radiographics 2010; 29:1939-54. [PMID: 19926755 DOI: 10.1148/rg.297095048] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronary artery dilatations-aneurysms and ectasia-are an uncommon and frequently unrecognized incidental finding in patients with coronary artery disease. Aneurysms and ectasia are associated with a vast group of disorders, and the evaluation and characterization of coronary aneurysms and ectasia represent a great diagnostic task with clinical and therapeutic implications. The underlying etiology is variable and includes degenerative, congenital, inflammatory, infectious, toxic, and traumatic causes. Unlike aneurysms, ectasia is more frequently seen in association with atherosclerosis or as a compensatory mechanism in those cases in which a proximal stenosis is noted in the opposite coronary artery; ectasia is also seen in some coronary artery anomalies, such as anomalous origin from the pulmonary artery, or as a result of a high-flow state, as seen in coronary artery fistulas. The diagnostic approach depends on the clinical scenario, and nowadays, noninvasive evaluation with multidetector computed tomography is possible. Imaging assessment should include evaluation of (a) the distribution, (b) maximal diameter, (c) presence or absence of intraluminal thrombi, (d) number, (e) extension, and (f) associated complications such as myocardial infarction. This article presents an overview of the definition, classification, etiology, clinical manifestations, and potential complications of coronary artery aneurysms and ectasia.
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Affiliation(s)
- Mariana Díaz-Zamudio
- Department of Radiology and Imaging, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Patanè S, Marte F, Sturiale M, Grassi R, Patanè F. Significant coronary artery disease associated with coronary artery aneurysm and elevation of prostate-specific antigen during acute myocardial infarction. Int J Cardiol 2009; 141:e39-42. [PMID: 19138808 DOI: 10.1016/j.ijcard.2008.11.151] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 11/26/2008] [Indexed: 11/25/2022]
Abstract
Coronary artery aneurysms are defined as coronary dilatations which exceed the diameter of normal adjacent segments by 1.5 times. Although more commonly associated with atherosclerosis, a variety of other acquired (eg, inflammatory, infectious, iatrogenic) or congenital causes have been identified that lead to impaired vessel media. 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 rupture. Other complications relate to the size of the aneurysm and compression of adjacent structures. Prostate-specific antigen (PSA) is an established marker for detection of prostate cancer. Elevation of prostate-specific antigen as well as its diminution during acute myocardial infarction has also been reported. It seems that when elevation of prostate-specific antigen occurs during acute myocardial infarction, coronary lesions are frequent and often more severe than when diminution of prostate-specific antigen occurs. PSA has been identified as a member of the human kallikrein family of serine proteases. In recent years, numerous observations have suggested that the activity of the kallikrein-kinin system is related to inflammation and to cardiovascular diseases. We present a case of elevation of serum PSA concentration during acute myocardial infarction in a 64-year-old Italian man with significant coronary artery disease and coronary artery aneurysm. Also this case confirms previous findings and extends the evaluation of PSA during acute myocardial infarction. It confirms a possible new intriguing scenario of the role of the prostate-specific antigen in acute myocardial infarction.
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