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Sohail AA, Wahab R, Rehman HU, Fatimi A, Fatimi SH. A rare case of diffuse ectasia in the coronary arteries and proximal aneurysm in the left anterior descending artery: A case report. Int J Surg Case Rep 2023; 111:108795. [PMID: 37713962 PMCID: PMC10507129 DOI: 10.1016/j.ijscr.2023.108795] [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: 07/30/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION Coronary artery aneurysm is defined as dilatation of a segment of coronary artery, greater than 1.5 times the diameter of the largest normal coronary artery of the patient. Major cause of coronary artery aneurysm is coronary artery disease. Coronary artery aneurysm maybe an incidental finding during coronary angiography or it may present with symptoms including chest pain, myocardial infarction or even death. CASE PRESENTATION We present a rare case of a 59-year-old gentleman, who had, previously, underwent multiple left heart catheterizations and percutaneous coronary interventions. He presented to us with symptomatic diffuse ectasia of the coronary arteries with proximal aneurysm in the Left Anterior Descending Artery. DISCUSSION Coronary artery aneurysms are very rare with an incidence of about 0.02 %-0.04 % and a prevalence of 0.3 %-12 %. Right Coronary Artery is the principal site coronary artery aneurysms with a predominance of 83.8 %. The occurrence of multiple aneurysms is a very rare finding. About 73 % patients present with single aneurysms while only 27 % present with multiple aneurysms. Coronary artery aneurysms predispose to various complications including compression of the chambers, thrombosis and rupture. CONCLUSION From the presented case it can be concluded that even though, conservative management is available, surgical repair is the gold standard treatment, especially in the presence of multiple, symptomatic and large aneurysms in order to avoid fatal ischemic complications.
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Affiliation(s)
- Abdul Ahad Sohail
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Rida Wahab
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Haseeb Ur Rehman
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Asad Fatimi
- Aga Khan University Hospital, Karachi, Pakistan.
| | - Saulat Hasnain Fatimi
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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2
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Tlohi I, Karim F, Elamraoui A, Drighil A, Habbal R. ST-elevation myocardial infarction complicated by ventricular tachycardia revealing coronary artery ectasia: a case report. J Med Case Rep 2023; 17:232. [PMID: 37277850 DOI: 10.1186/s13256-023-03965-3] [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: 01/16/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Coronary artery ectasia is a rare angiographic finding and results from a disease process that compromises the integrity of the vessel wall. Its prevalence ranges between 0.3% and 5% of patients undergoing coronary angiography (Swaye et al. in Circulation 67:134-138, 1983). Coronary artery ectasia in patients with ST-elevation myocardial infarction is associated with an increased risk of cardiovascular events and death after percutaneous coronary intervention. CASE PRESENTATION We report the case of a 50-year-old male Caucasian patient, admitted for ventricular tachycardia at 200 beats per minute hemodynamically not tolerated that was reduced by external electric shock. Electrocardiogram after cardioversion showed a sinus rhythm with anterior ST-elevation myocardial infarction. Thrombolytic therapy was chosen after exposure to dual antiplatelet therapy and heparin since the expected time to percutaneous coronary intervention was greater than 120 minutes from first medical contact and the patient presented within 12 hours of onset of ischemic symptoms. The electrocardiogram after thrombolysis showed the resolution of the ST segment. The echocardiogram showed a dilated left ventricle with severe dysfunction with left ventricle ejection fraction at 30%. Coronary angiography revealed non-obstructive giant ecstatic coronaries without any thrombus. A check-up to look for possible etiologies for coronary artery ectasia was carried out and returned normal. Since no etiology for coronary artery ectasia was found at the limit of available exams in our center, the patient was discharged with antiplatelet therapy (aspirin 100 mg once a day) and heart failure treatment with an indication for an implantable cardiac defibrillator. CONCLUSIONS Coronary artery ectasia in the context of acute myocardial infarction is a rare condition that may have dangerous complications, especially when an optimal treatment for ecstatic culprit vessels is still controversial.
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Affiliation(s)
- Imane Tlohi
- Department of Cardiology, IBN ROCHD University Hospital, 1 rue des hopitaux 20360, Casablanca, Morocco.
| | - Fatiha Karim
- Department of Cardiology, IBN ROCHD University Hospital, 1 rue des hopitaux 20360, Casablanca, Morocco
| | - Asmaa Elamraoui
- Department of Cardiology, IBN ROCHD University Hospital, 1 rue des hopitaux 20360, Casablanca, Morocco
| | - Abdenasser Drighil
- Department of Cardiology, IBN ROCHD University Hospital, 1 rue des hopitaux 20360, Casablanca, Morocco
| | - Rachida Habbal
- Department of Cardiology, IBN ROCHD University Hospital, 1 rue des hopitaux 20360, Casablanca, Morocco
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3
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Rostam-Alilou AA, Safari M, Jarrah HR, Zolfagharian A, Bodaghi M. A machine learning model for non-invasive detection of atherosclerotic coronary artery aneurysm. Int J Comput Assist Radiol Surg 2022; 17:2221-2229. [PMID: 35948765 DOI: 10.1007/s11548-022-02725-w] [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: 01/28/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Atherosclerosis plays a significant role in the initiation of coronary artery aneurysms (CAA). Although the treatment options for this kind of vascular disease are developing, there are challenges and limitations in both selecting and applying sufficient medical solutions. For surgical interventions, that are novel therapies, non-invasive specific patient-based studies could lead to obtaining more promising results. Despite medical and pathological tests, these pre-surgical investigations require special biomedical and computer-aided engineering techniques. In this study, a machine learning (ML) model is proposed for the non-invasive detection of atherosclerotic CAA for the first time. METHODS The database for study was collected from hemodynamic analysis and computed tomography angiography (CTA) of 80 CAAs from 61 patients, approved by the Institutional Review Board (IRB). The proposed ML model is formulated for learning by a one-class support vector machine (1SVM) that is a field of ML to provide techniques for outlier and anomaly detection. RESULTS The applied ML algorithms yield reasonable results with high and significant accuracy in designing a procedure for the non-invasive diagnosis of atherosclerotic aneurysms. This proposed method could be employed as a unique artificial intelligence (AI) tool for assurance in clinical decision-making procedures for surgical intervention treatment methods in the future. CONCLUSIONS The non-invasive diagnosis of the atherosclerotic CAAs, which is one of the vital factors in the accomplishment of endovascular surgeries, is important due to some clinical decisions. Although there is no accurate tool for managing this kind of diagnosis, an ML model that can decrease the probability of endovascular surgical failures, death risk, and post-operational complications is proposed in this study. The model is able to increase the clinical decision accuracy for low-risk selection of treatment options.
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Affiliation(s)
- Ali A Rostam-Alilou
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Marziyeh Safari
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Hamid R Jarrah
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Ali Zolfagharian
- School of Engineering, Deakin University, Geelong, 3216, Australia
| | - Mahdi Bodaghi
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK.
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4
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Esposito L, Di Maio M, Silverio A, Cancro FP, Bellino M, Attisano T, Tarantino FF, Esposito G, Vecchione C, Galasso G, Baldi C. Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma. Front Cardiovasc Med 2022; 8:805727. [PMID: 35187112 PMCID: PMC8854288 DOI: 10.3389/fcvm.2021.805727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/27/2021] [Indexed: 12/19/2022] Open
Abstract
Coronary artery ectasia (CAE) is defined as a diffuse or focal dilation of an epicardial coronary artery, which diameter exceeds by at least 1. 5 times the normal adjacent segment. The term ectasia refers to a diffuse dilation, involving more than 50% of the length of the vessel, while the term aneurysm defines a focal vessel dilation. CAE is a relatively uncommon angiographic finding and its prevalence ranges between 0.3 and 5% of patients undergoing coronary angiography. Although its pathophysiology is still unclear, atherosclerosis seems to be the underlying mechanism in most cases. The prognostic role of CAE is also controversial, but previous studies reported a high risk of cardiovascular events and mortality in these patients after percutaneous coronary intervention. Despite the availability of different options for the interventional management of patients with CAE, including covered stent implantation and stent-assisted coil embolization, there is no one standard approach, as therapy is tailored to the individual patient. The abnormal coronary dilation, often associated with high thrombus burden in the setting of acute coronary syndromes, makes the interventional treatment of CAE patients challenging and often complicated by distal thrombus embolization and stent malapposition. Moreover, the optimal antithrombotic therapy is debated and includes dual antiplatelet therapy, anticoagulation, or a combination of them. In this review we aimed to provide an overview of the pathophysiology, classification, clinical presentation, natural history, and management of patients with CAE, with a focus on the challenges for both clinical and interventional cardiologists in daily clinical practice.
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Affiliation(s)
- Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- *Correspondence: Luca Esposito
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Tiziana Attisano
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Vascular Pathophysiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Cesare Baldi
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
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5
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El Khoury M, Anugu VR, Salmane C, Karam B, Imam M, Warchol A. Giant Coronary Artery Aneurysm: A Successful Diagnosis. Cureus 2021; 13:e20429. [PMID: 35047266 PMCID: PMC8759980 DOI: 10.7759/cureus.20429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
Coronary artery aneurysms (CAAs) are rare, with giant CAAs being even rarer. The precise pathophysiology of this phenomenon is still unknown. CAAs are seldom reported life-threatening abnormalities of the cardiovascular system. We herein present a case of a 74-year-old man who presented at the hospital complaining of chest pain. An adenosine thallium scan revealed a small, reversible defect in the inferior wall of the left ventricle extending into the apex, consistent with ischemia. Echocardiography uncovered a large right coronary artery (RCA) aneurysm, measuring 5.6 × 7.5 cm. Diagnostic coronary angiography confirmed the presence of a large RCA aneurysm and aneurysmal dilation of the left anterior descending and circumflex arteries with no flow-limiting lesions. A reversed saphenous vein interposition graft was placed from the ascending aorta to the right posterior descending artery. The RCA aneurysmal sac was resected and sent to pathology, which uncovered myxoid degeneration of the media as well as thrombus formation. No complications were encountered during the procedure. Early diagnosis is vital to avoid fatal complications of CAAs, and therapeutic approaches are currently individualized in view of absence of evidence-based management strategies.
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Matta AG, Yaacoub N, Nader V, Moussallem N, Carrie D, Roncalli J. Coronary artery aneurysm: A review. World J Cardiol 2021; 13:446-455. [PMID: 34621489 PMCID: PMC8462041 DOI: 10.4330/wjc.v13.i9.446] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/09/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
Coronary artery aneurysm (CAA) is a clinical entity defined by a focal enlargement of the coronary artery exceeding the 1.5-fold diameter of the adjacent normal segment. Atherosclerosis is the main cause in adults and Kawasaki disease in children. CAA is a silent progressive disorder incidentally detected by coronary angiography, but it may end with fatal complications such as rupture, compression of adjacent cardiopulmonary structures, thrombus formation and distal embolization. The pathophysiological mechanisms are not well understood. Atherosclerosis, proteolytic imbalance and inflammatory reaction are involved in aneurysmal formation. Data from previously published studies are scarce and controversial, thereby the management of CAA is individualized depending on clinical presentation, CAA characteristics, patient profile and physician experience. Multiple therapeutic approaches including medical treatment, covered stent angioplasty, coil insertion and surgery were described. Herein, we provide an up-to-date systematic review on the pathophysiology, complications and management of CAA.
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Affiliation(s)
- Anthony Georges Matta
- Department of Cardiology, Toulouse University Hospital, Rangueil, Toulouse 31400, France
- Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh 961, Lebanon
| | - Nabil Yaacoub
- Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh 961, Lebanon
| | - Vanessa Nader
- Department of Cardiology, Toulouse University Hospital, Rangueil, Toulouse 31400, France
- Faculty of Pharmacy, Lebanese University, Hadath 961, Lebanon
| | - Nicolas Moussallem
- Division of Cardiology, Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh 961, Lebanon
| | - Didier Carrie
- Department of Cardiology, University Hospital Rangueil, Toulouse 31059, France
| | - Jerome Roncalli
- Department of Cardiology, University Hospital of Toulouse/Institute Cardiomet, Toulouse 31400, France
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7
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Amirghofran AA, Golchin Vafa R, Kojuri J. Huge Coronary Aneurysm in a Morbidly Obese Man with Exertional Dyspnea and Chest Pain. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932786. [PMID: 34482358 PMCID: PMC8428619 DOI: 10.12659/ajcr.932786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patient: Male, 64-year-old
Final Diagnosis: Huge coronary aneurysm
Symptoms: Chest discomfort • dyspnea
Medication: Losar 25 mg twice daily • Amlodipine 5 mg twice daily • Aspirin 80 mg daily • Atorovastatin 20 mg daily • Pantaprazole 20 mg daily
Clinical Procedure: Coronary artery bypass graft surgery
Specialty: Cardiac Surgery • Cardiology
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Affiliation(s)
| | - Reza Golchin Vafa
- Department of Cardiology, Professor Kojuri Cardiology Clinic, Shiraz, Iran
| | - Javad Kojuri
- Department of Cardiology, Professor Kojuri Cardiology Clinic, Shiraz, Iran.,Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran.,Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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8
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Coronary Anomalies in 11,267 Southwest Chinese Patients Determined by Angiography. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6693784. [PMID: 33681376 PMCID: PMC7910051 DOI: 10.1155/2021/6693784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022]
Abstract
Background The prevalence of coronary artery anomalies (CAAs) is rare and varies among different countries or areas. More importantly, the symptoms exhibited by some CAAs make the diagnosis of coronary artery disease (CAD) difficult and hamper the physician from making the right intervention for CAD patients. Objective To investigate the prevalence of CAAs in 11,267 patients from three hospitals in Southwest China. Methods 11,267 patients who have undergone coronary angiography from three Southwest China hospitals were investigated retrospectively. Dominance patterns, prevalence, and the location of each CAA were recorded and analyzed. Results The presence of a dominant right coronary artery (RCA) was found in 60.58% of patients. CAAs were found in 11.12% (1258) patients, and 87.66% anomalies were located in the left anterior descending (LAD) artery and its branches. Most of CAAs were found to be myocardial bridges (MBs, 1060 cases, 9.41%). Other CAAs included anomalous coronary origin (43 cases, 0.38%), coronary artery fistulas (CAFs, 36 cases, 0.32%), and coronary artery aneurysm or ectasia (119 cases, 1.06%). It also noted that most anomalies were found with RCA originating from the left coronary sinus (79.07%), most CAFs were located in the LAD and its branches (58.33%), and most coronary artery ectasias were located in the RCA (43.25%). Conclusions CAAs in patients from Southwest China were unique compared to other studies. Recognition of these CAAs is important for accurate diagnosis and treatment choice of patients with chest pain.
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9
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Gupta A, Datta R, Chhikara S, Dhagat PK, Vijayvergiya R. Coronary Artery Aneurysm After Drug-Eluting Stent Implantation Causing Coronary-Bronchial Fistula. JACC Case Rep 2020; 2:1692-1697. [PMID: 34317036 PMCID: PMC8312138 DOI: 10.1016/j.jaccas.2020.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 11/04/2022]
Abstract
Coronary artery aneurysm (CAA) after drug-eluting stent implantation is rare, with a reported incidence of 0.3% to 6.0%. Most of these aneurysms are asymptomatic. Hemoptysis as a presentation of CAA is very rare. The patient in our case had CAA after zotarolimus-eluting stent implantation and presented with hemoptysis resulting from a leaking coronary-bronchial fistula. (Level of Difficulty: Intermediate.).
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Key Words
- BMS, bare metal stent(s)
- CAA, coronary artery aneurysm
- CT, computed tomography
- DES, drug-eluting stent(s)
- ECG, electrocardiogram
- LA, left atrial
- LAD, left anterior descending
- LCX, left circumflex
- LM, left main (coronary artery)
- LV, left ventricular
- NC, noncompliant
- PCI, percutaneous coronary intervention
- complication
- coronary angiography
- percutaneous coronary intervention
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Affiliation(s)
- Ankush Gupta
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India
| | - Rajat Datta
- Department of Cardiology, Army Hospital Research and Referral, New Delhi, India
| | - Sanya Chhikara
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India
| | - Peeyush K. Dhagat
- Department of Radiology, Base Hospital Delhi Cantt, New Delhi, India
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10
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Ahmed T, Chahal D, Shkullaku M, Gupta A. Extensive coil embolization of a giant coronary artery aneurysm in an octogenarian: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32617506 PMCID: PMC7319851 DOI: 10.1093/ehjcr/ytaa074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Indexed: 12/16/2022]
Abstract
Background Coronary artery aneurysms (CAA) are often diagnosed incidentally on coronary angiography or imaging modalities done for other reasons. ‘Giant’ CAA by definition exceeds 20 mm in diameter or four times the diameter of normal coronary artery. The management of patients with CAAs is challenging due to poorly understood mechanism, variable presentation, and lack of clear-cut societal recommendations. Though conservative management is preferred in asymptomatic patients, massive size or interval growth may make intervention necessary. Case summary We describe a case of successful coil embolization of a giant coronary aneurysm in an elderly 84-year-old male. Patient, who presented for a follow-up computed tomography angiography to evaluate a previously repaired abdominal aortic aneurysm 2 years back, was found to have interval growth of right coronary artery aneurysm from 4 cm in diameter to 7 × 8 cm in its greatest dimensions. The rationale for treatment was to prevent sudden death from continued growth and eventual rupture of aneurysm in addition to potential risk of thromboembolism and compression of adjacent structures. Discussion This case demonstrates the safe and successful use of extensive coil embolization technique to treat a ‘giant’ CAA in an elderly patient when surgical risks were prohibitive.
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Affiliation(s)
- Talha Ahmed
- University of Maryland Midtown Campus, 827 Linden Avenue, Baltimore, MD 21209, USA
| | - Diljon Chahal
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Anuj Gupta
- University of Maryland School of Medicine, Baltimore, MD, USA
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11
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JIN CHUNBO, MAO BOYAN, LI BAO, FENG YUE, WU DANDAN, XIE JINSHENG, LIU YOUJUN. HEMODYNAMIC STUDY OF CORONARY ARTERY ANEURYSMS. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420500128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: When the coronary artery expands more than two times its diameter, it will form a coronary artery aneurysm (CAA). CAA can lead to myocardial ischemia. In this paper, the mechanism of myocardial ischemia induced by CAA was studied by geometric multiscale method. Methods: Four kinds of three-dimensional models of CAA with different dilation diameters were established on the basis of normal three-dimensional models. The dilation diameters were 2, 3, 5 and 7 times, capacitance was added after the CAA to simulate the elasticity of the vascular wall. Results:A large number of eddies exist in CAA. 2–7 times model: 1.1–14.4% reduction of blood flow downstream of CAA and 5, 7 times model showed upstream diastolic backward flow, the backward flow rate was 1.1% and 5.6%, respectively. The aveWSS at the CAA was 1.76–0.35[Formula: see text]Pa; the relative retention time was 1.1–14.6[Formula: see text]Pa[Formula: see text]; the average vorticity was 0.0085–231.7[Formula: see text]s[Formula: see text]. Conclusion:CAA can store blood, and the elasticity of the wall of CAA results in the flow of blood upstream. These two reasons make the downstream flow of CAA decrease and easily form intratumoral thrombosis, which may lead to myocardial ischemia.
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Affiliation(s)
- CHUNBO JIN
- College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, Beijing, P. R. China
| | - BOYAN MAO
- College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, Beijing, P. R. China
| | - BAO LI
- College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, Beijing, P. R. China
| | - YUE FENG
- College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, Beijing, P. R. China
| | - DANDAN WU
- College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, Beijing, P. R. China
| | - JINSHENG XIE
- Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, P. R. China
| | - YOUJUN LIU
- College of Life Science and Bio-engineering, Beijing University of Technology, No.100 Pingleyuan, Chaoyang District, Beijing, P. R. China
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12
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Giant right coronary artery aneurysm mimicking a right intra-ventricular mass: a case report. J Cardiothorac Surg 2020; 15:17. [PMID: 31931838 PMCID: PMC6958741 DOI: 10.1186/s13019-020-1054-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Coronary artery aneurysm is a rare condition which constitutes a small proportion of coronary artery disease. Such condition mimicking an intra-cardiac mass is extremely rare and poorly understood. Case presentation We present an unusual case of a 53-year-old female with decreased exercise tolerance and lower extremity edema for 3 months. The echocardiography showed moderate tricuspid regurgitation and a right intra-ventricular mass below the tricuspid valve. No ventricular wall akinesia or ST segment change was found on echocardiography or electrocardiogram. Coronary computed tomographic angiography confirmed the diagnosis of intra-ventricular mass with feeding vessel originated from the right coronary artery. The patient was scheduled for tumor resection, and the mass turned out to be a thrombosed giant right coronary artery aneurysm. The patient received successful aneurysm resection and had an uneventful postoperative recovery. Unfortunately, a fistula between right coronary artery and right ventricle was detected on follow-up three months later by echocardiography. Conclusions Coronary artery aneurysms presenting as intra-cardiac masses are extremely rare. Comprehensive preoperative evaluation is highly recommended because the surgical strategies for tumor and aneurysm are completely different. Aneurysm resection with bypass surgery is preferred rather than aneurysm repair. To our best knowledge, coronary artery aneurysms presenting as intra-ventricular masses have seldom been reported.
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13
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Garatti A, Daprati A, Saitto G, deVincentiis C, Menicanti L. Surgical management of multiple giant coronary artery aneurysms determining myocardial ischemia. J Card Surg 2019; 35:211-213. [DOI: 10.1111/jocs.14276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Andrea Garatti
- Department of Cardiovascular Disease “E. Malan”, Cardiac Surgery Unit IRCCS Policlinico S. Donato Hospital Milan Italy
| | - Andrea Daprati
- Department of Cardiovascular Disease “E. Malan”, Cardiac Surgery Unit IRCCS Policlinico S. Donato Hospital Milan Italy
| | - Guglielmo Saitto
- Department of Cardiovascular Disease “E. Malan”, Cardiac Surgery Unit IRCCS Policlinico S. Donato Hospital Milan Italy
| | - Carlo deVincentiis
- Department of Cardiovascular Disease “E. Malan”, Cardiac Surgery Unit IRCCS Policlinico S. Donato Hospital Milan Italy
| | - Lorenzo Menicanti
- Department of Cardiovascular Disease “E. Malan”, Cardiac Surgery Unit IRCCS Policlinico S. Donato Hospital Milan Italy
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14
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Afzal A, Mobin S, Sharbatji M, Nawaz H, Siddiqui M. Rare Case of Giant Asymptomatic Left Coronary Artery Aneurysm of 10 cm Associated with Coronary Cameral Fistula. Cureus 2018; 10:e3566. [PMID: 30648098 PMCID: PMC6329617 DOI: 10.7759/cureus.3566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A giant coronary artery aneurysm (CAA) associated with a coronary cameral fistula is an extremely rare finding. Most cases of CAAs are asymptomatic. The incidence of CAA varies between 0.3% to 5.3%. Due to advancements in diagnostic technologies, the incidence of CAA is on the rise. Even in the modern days of medical science, the clinical course of CAA is still unpredictable and the suitable timing for the treatment of CAA is still open to debate. We reported a case of a giant coronary artery aneurysm in a 38-year-old female, which was 9.4 x 9.7 x 9.2cm in size, arising from the left coronary artery, extending into the proximal circumflex, and draining into the right atrium, forming a fistula tract. The patient was diagnosed with the help of coronary computed tomography (CT) and cardiac catheterization after which surgery was performed to repair the aneurysm and fistula. Postoperatively, the patient recovered without any complication.
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Affiliation(s)
- Ali Afzal
- Internal Medicine, Florida Hospital, Orlando, USA
| | - Syed Mobin
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | | - Hussain Nawaz
- Internal Medicine, Aga Khan University Hospital, Lahore, PAK
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15
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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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16
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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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17
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Abstract
This case presents a woman in her early 20s who died after the sudden onset of chest pain. Five years earlier, she was investigated for a cardiac murmur during pregnancy and an echocardiogram revealed a 6.0×3.0 cm blood-filled sac compressing the left atrium and anterolateral aspect of the left ventricle with communication to the aortic root. She later had a CT scan of the chest with contrast, which showed aneurysmal dilatation of the left main coronary artery. She was placed on aspirin but defaulted from clinic 11 months post partum. At autopsy, a left coronary aneurysmal sac measuring 10.0×9.0 cm. was identified with a rupture measuring 7.0 cm in length and the pericardial sac contained 900 mL of blood with clots. The cause of death was cardiac tamponade secondary to rupture of the coronary artery aneurysm.
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Affiliation(s)
- Alicia Blackman
- Department of Anatomical Pathology, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad and Tobago
| | - Wayne Mohammed
- Department of ParaClinical, University of the West Indies at Saint Augustine, Champs Fleurs, Trinidad and Tobago
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18
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Severe Dilatation of Coronary Artery Ostium Complicating Sinus of Valsalva Aneurysm: Differential Diagnosis and Review of the Literature. Case Rep Cardiol 2017; 2017:8694652. [PMID: 28487777 PMCID: PMC5406726 DOI: 10.1155/2017/8694652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/26/2017] [Indexed: 11/17/2022] Open
Abstract
Coronary artery dilatation may be due to various aetiologies including congenital anomalies, atherosclerotic coronary disease, and Kawasakis disease. We describe a case characterised by apparent severe dilatation of the right coronary artery ostium in an asymptomatic male. Subsequent imaging and surgical intervention documented the presence of a sinus of Valsalva aneurysm extending into the ostium of the right coronary artery. This represents an unusual manifestation of a sinus of Valsalva aneurysm. The underlying pathophysiology, differential diagnosis, role of surgical management, and outcomes are discussed.
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19
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Lee WC, Fang HY, Fang CY. Hybrid Strategy to Treat Life-Threatening Giant Coronary Artery Aneurysm With Severe In-Stent Restenosis. Int Heart J 2017; 58:283-285. [DOI: 10.1536/ihj.16-233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
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20
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Abstract
INTRODUCTION Coronary artery aneurysm (CAA) is defined as coronary dilatation which exceeds the diameter of the normal adjacent artery segments or the diameter of the patient's largest coronary artery by 1.5 times. The incidence of giant CAA is difficult to be determined, since only few reports have been described in the literature. METHODS AND RESULTS A 65-year-old man was referred to our hospital because of a "mass" in the right heart detected on echocardiography at a regular medical health examination, while he experienced no any symptoms. Coronary angiography showed the severe stenosis of the left anterior descending artery (LAD) and the left circumflex artery (LCX) and the diffusely ectatic change of the right coronary artery (RCA), but no mass was found in any of these arteries. Coronary computed tomography angiography (CTA) confirmed that the "mass" was the giant aneurysms of RCA with thrombus. He received coronary artery bypass graft (CABG) with thrombectomy. The histopathology showed the deposits of lipid and hyalin in the tunica intima, the focal calcifications, the very thin tunica media, and the disappearance of the part of the tunica media in the RCA. CONCLUSIONS Coronary artery aneurysm which may contain thrombus can complicate a diagnostic coronary angiography due to the risk of distal embolization and may lead to myocardial infarction. This case report demonstrates 2 RCA aneurysms with a thrombus presenting as a giant "mass" which was successfully treated by CABG with thrombectomy.
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Affiliation(s)
- Huanhuan Wang
- Division of Cardiology
- Correspondence: Huanhuan Wang, Division of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China (e-mail: )
| | | | | | - Hongyue Wang
- Division of Pathology, Fuwai Hospital, National Center for Cardiovascular Disease, Beijing, China
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21
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Al Salihi S, Jacobi E, Hunter R, Buja M. Multiple giant coronary artery aneurysms: a case report. Cardiovasc Pathol 2016; 25:203-207. [PMID: 26878103 DOI: 10.1016/j.carpath.2016.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/30/2015] [Accepted: 01/05/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Coronary artery aneurysm is defined as a localized area of dilatation exceeding the diameter of the adjacent normal arterial segment by 50%. Giant aneurysms are those aneurysms that measure greater than 2cm in diameter. There have been many pathologic diseases, including atherosclerosis, that have been implicated in the development of coronary artery aneurysms. MATERIALS AND METHODS We report a case of a 61-year-old African American male with multiple comorbidities including hypertension, congestive heart failure, abdominal aortic aneurysm, and bilateral iliac aneurysms, who was admitted to our hospital with exacerbation of congestive heart failure. Less than 2weeks after admission, the patient suffered cardiac arrest while receiving dialysis and was unresponsive to resuscitative measures. FINDINGS Autopsy was performed and revealed significant cardiomyopathy and giant coronary artery aneurysms involving the left anterior descending, left circumflex, and right coronary arteries. Both ventricles showed hypertrophy and dilation with multifocal areas of chronic myocardial scarring. CONCLUSIONS Coronary artery aneurysms and giant coronary artery aneurysms are an uncommon. As there are few reported cases in the literature, the cause, detection, and treatment of this disease are still largely unknown.
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Affiliation(s)
- S Al Salihi
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - E Jacobi
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - R Hunter
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M Buja
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
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22
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Tamene AM, Saxena R, Grizzard JD, Shenoy C. Asymptomatic progression of an atherosclerotic giant right coronary artery aneurysm over 12 years: characterization using cardiovascular magnetic resonance and computed tomography imaging. Circulation 2015; 131:e360-2. [PMID: 25737505 DOI: 10.1161/circulationaha.114.012275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashenafi M Tamene
- From Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis (A.M.T., C.S.); North Memorial Heart and Vascular Institute, Minneapolis, MN (R.S.); and Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA (J.D.G.)
| | - Retu Saxena
- From Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis (A.M.T., C.S.); North Memorial Heart and Vascular Institute, Minneapolis, MN (R.S.); and Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA (J.D.G.)
| | - John D Grizzard
- From Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis (A.M.T., C.S.); North Memorial Heart and Vascular Institute, Minneapolis, MN (R.S.); and Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA (J.D.G.)
| | - Chetan Shenoy
- From Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, Minneapolis (A.M.T., C.S.); North Memorial Heart and Vascular Institute, Minneapolis, MN (R.S.); and Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, VA (J.D.G.).
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23
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Low-dose antithrombotic treatment in coronary thrombosis of Kawasaki disease. Pediatr Cardiol 2015; 36:503-8. [PMID: 25298222 DOI: 10.1007/s00246-014-1040-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 09/27/2014] [Indexed: 01/19/2023]
Abstract
To explore effective and convenient rescue therapy options for coronary artery aneurysms (CAA) with thrombosis in Kawasaki disease (KD). A total of 210 patients with KD between the years 2003 and 2013 were retrospectively reviewed in our institute. 144 of these 210 KD developed CAA, and 10 patients with CAA had associated thrombosis. Thrombosis was confirmed by two-dimensional echocardiograms (2-DE). Laboratory values for CAA were analyzed with and without the thrombus group. The characteristics of CAA were monitored by ultrasound. All patients with thrombus received intravenous (IV) antithrombotic therapy, including urokinase, heparin, and oral warfarin. The effectiveness of antithrombotic treatment was evaluated by measuring the ability to dissolve the thrombus. All thrombi in these patients were preceded by a giant CAA and a history of KD. There are no differences in the blood analyses of both CAA with and without thrombus. Moreover, typical KD symptoms and acute myocardial infarction were not found in CAA with thrombosis. The progression of coronary thrombosis in these patients was arrested by antithrombotic and anti-platelet treatment including low-dose urokinase and heparin. Neither clinical features nor laboratory data could reliably predict CAA associated thrombosis. Therapy with IV anti-thrombus and anti-platelet treatment with low-dose warfarin can effectively dissolve thrombi in KD patients.
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24
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Monem M, Rampat R. An unusual cause of ST elevation myocardial infarction (STEMI). BMJ Case Rep 2014; 2014:bcr-2014-203981. [PMID: 25246457 DOI: 10.1136/bcr-2014-203981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 67-year-old Caucasian woman presented to clinic with a 2-month history of worsening shortness of breath on exertion and a single episode of chest pain 1 week before. Her ECG in clinic showed ST elevation inferiorly and she was admitted from clinic for further investigations as inpatient. She was initiated on the acute coronary syndrome protocol and underwent emergency left heart catheterisation on the day of admission. The coronary angiogram revealed large aneurysmal dilations in the right coronary artery and left main stem. A ventriculogram showed poor left ventricular (LV) systolic function in line with subsequent transthoracic echocardiogram, which revealed her to have an left ventricular ejection-fraction (LVEF) of approximately 20%. It was agreed with the cardiothoracic surgeons to treat the aneurysms non-operatively and start low-molecular weight heparin. Furthermore the underlying biventricular impairment was treated with ACE-inhibitors, β-blockers and diuretic therapy (loop and potassium-sparing). The strategy was to prevent further thrombus formation with the aneurysmal vessels and to achieve this the patient was initiated on lifelong warfarin. Other medical risk factors were optimised and patient started on statin medication. The aneurysm was monitored with serial CTs with a view to reconsider surgical intervention if any evidence of dilation. This case highlights an unusual cause of ST elevation myocardial infarction.
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25
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Sohns JM, Fasshauer M, Staab W, Steinmetz M, Lotz J, Unterberg-Buchwald C. Giant bypass aneurysm, a cause of suspected cardiac mass. SPRINGERPLUS 2014; 3:433. [PMID: 25184106 PMCID: PMC4148499 DOI: 10.1186/2193-1801-3-433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 07/22/2014] [Indexed: 12/04/2022]
Abstract
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.
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Affiliation(s)
- Jan M Sohns
- Institute for Diagnostic and Interventional Radiology, Center of Radiology, DZHK, Georg-August-University Göttingen, UMG Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany ; German Centre for Cardiovascular Research, DZHK, Göttingen, Germany
| | - Martin Fasshauer
- Institute for Diagnostic and Interventional Radiology, Center of Radiology, DZHK, Georg-August-University Göttingen, UMG Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany ; German Centre for Cardiovascular Research, DZHK, Göttingen, Germany
| | - Wieland Staab
- Institute for Diagnostic and Interventional Radiology, Center of Radiology, DZHK, Georg-August-University Göttingen, UMG Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany ; German Centre for Cardiovascular Research, DZHK, Göttingen, Germany
| | - Michael Steinmetz
- German Centre for Cardiovascular Research, DZHK, Göttingen, Germany ; Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University, Göttingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, Center of Radiology, DZHK, Georg-August-University Göttingen, UMG Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany ; German Centre for Cardiovascular Research, DZHK, Göttingen, Germany
| | - Christina Unterberg-Buchwald
- German Centre for Cardiovascular Research, DZHK, Göttingen, Germany ; Department of Cardiology and Pneumology, Georg-August-University, Göttingen, Germany
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Clarke J, Choong A, Raja S, Amrani M, Hellawell G, Hussain T. The management of concomitant renal oncocytoma and giant coronary and bilateral common iliac artery aneurysms. Ann Vasc Surg 2013; 28:1033.e11-5. [PMID: 24200531 DOI: 10.1016/j.avsg.2013.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/17/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022]
Abstract
We present the rare case of a 66-year-old Caucasian male patient presenting with intermittent left-side abdominal pain. He underwent a kidneys, ureters, and bladder computed tomography scan on which an incidental 45-mm giant aneurysm of the left anterior descending coronary artery was discovered along with 55-mm right-sided and 62-mm left-sided common iliac artery aneurysms and a 100-mm benign renal oncocytoma. He underwent on-pump coronary artery bypass grafting of the left anterior descending, left circumflex and right coronary arteries using internal mammary artery and saphenous vein grafts. He subsequently underwent simultaneous open left nephrectomy and bilateral common iliac aneurysm repair using a bifurcated tube graft. He made a full recovery postoperatively. Giant coronary artery aneurysms are rare. In the pediatric population, they are predominantly secondary to Kawasaki disease. In adults, atheromatous disease is the leading cause. The coexistence of giant coronary artery aneurysms with extracoronary artery aneurysms is extremely unusual. We propose that the identification of giant coronary artery aneurysms necessitates further imaging investigations to identify the presence of extracoronary aneurysms. To our knowledge, this is the first description of such a case in the literature.
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Affiliation(s)
- Jonathan Clarke
- Outer North West London Regional Vascular Unit, North West London Hospitals National Health Service Trust, Northwick Park Hospital, Watford Road, Harrow, UK.
| | - Andrew Choong
- Outer North West London Regional Vascular Unit, North West London Hospitals National Health Service Trust, Northwick Park Hospital, Watford Road, Harrow, UK; Department of Surgery, University of Queensland, Brisbane, Australia
| | - Shahzad Raja
- Department of Cardiothoracic Surgery, The Royal Brompton and Harefield National Health Service Trust, Harefield Hospital, Hill End Road, Harefield, UK
| | - Mohamed Amrani
- Department of Cardiothoracic Surgery, The Royal Brompton and Harefield National Health Service Trust, Harefield Hospital, Hill End Road, Harefield, UK
| | - Giles Hellawell
- Department of Urological Surgery, North West London Hospitals National Health Service Trust, Northwick Park Hospital, Watford Road, Harrow, UK
| | - Tahir Hussain
- Outer North West London Regional Vascular Unit, North West London Hospitals National Health Service Trust, Northwick Park Hospital, Watford Road, Harrow, UK
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27
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Avgerinos DV, Salemi A. Surgical management of multiple coronary artery aneurysms. J Card Surg 2013; 28:383-5. [PMID: 23594117 DOI: 10.1111/jocs.12105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe the surgical management of three distinct coronary artery aneurysms in conjunction with coronary artery bypass grafting.
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Affiliation(s)
- Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, New York Presbyterian - Weill Cornell Medical Center, New York, New York 10065, USA.
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28
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Berdajs D, Ruchat P, Suva M, Ferrari E, Ligang L, von Segesser LK. Congenital giant aneurysm of the left coronary artery. Heart Lung Circ 2011; 20:663-5. [PMID: 21478051 DOI: 10.1016/j.hlc.2011.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 01/24/2011] [Accepted: 02/14/2011] [Indexed: 11/27/2022]
Abstract
We report an unusual case of congenital giant coronary aneurysm. A 23 year-old male with a history of acute myocardial infarction presented an abnormal shadow in the left cardiac border on routine X-ray. Electrocardiogram and physical examination were normal without any clinical signs of inflammation, but computed tomography (CT) scan and cardiac magnetic resonance imaging (MRI) revealed a giant (>50mm) coronary aneurysm. Coronary artery bypass grafting (CABG) with coronary artery aneurysm (CAA) resection resolved the CAA. Coronary artery aneurysms are entities of localised dilation and can be common events in chronic infectious disease as a result of the systemic inflammatory state; however, giant coronary aneurysms (measuring more than 50mm) are rare. This is especially true where the pathological aetiology was not clearly defined or was believed to be of congenital origin. To date only a few published case reports exist for this type of pathological entity.
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Affiliation(s)
- Denis Berdajs
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
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29
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Taguchi E, Sawamura T, Kamio T, Fukunaga T, Oe Y, Miyamoto S, Koyama J, Tayama S, Sakamoto T, Nishigami K, Honda T, Hirayama T, Nakao K. An autopsy case of the rupture of a giant aneurysm in a saphenous vein graft: 18 years after CABG. J Cardiol Cases 2010; 2:e88-e91. [PMID: 30524595 DOI: 10.1016/j.jccase.2010.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 03/25/2010] [Accepted: 03/29/2010] [Indexed: 10/19/2022] Open
Abstract
The saphenous vein is a widely used blood vessel for arterial bypass procedures. Failures of saphenous vein aortocoronary bypass grafts are predominantly the result of subsequent vein graft atherosclerotic disease. Rarely saphenous vein grafts undergo aneurysmal degeneration. This report describes a case of a ruptured aneurysm in a saphenous vein graft that occurred in an 82-year-old female who underwent a coronary artery bypass operation 18 years previously. We could not resuscitate her, but describe the autopsy findings in detail.
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Affiliation(s)
- Eiji Taguchi
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Tadashi Sawamura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Takihiro Kamio
- Division of Pathology, Saiseikai Kumamoto Hospital Laboratory Center, Kumamoto, Japan
| | - Takashi Fukunaga
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Yoko Oe
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Shinzo Miyamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Junjiroh Koyama
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Shinji Tayama
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Kazuhiro Nishigami
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Toshihiro Honda
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
| | - Touitsu Hirayama
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Cardiovascular Center, Kumamoto, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital, Cardiovascular Center, 5-3-1 Chikami, Kumamoto, Japan
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