1
|
Furui M, Matsumura H, Hayashida Y, Kuwahara G, Shimizu M, Morita Y, Matsuoka Y, Ito C, Hayama M, Wakamatsu K, Wada H. Repair of a right coronary artery rupture with perforated right ventricle following spontaneous pseudoaneurysm: a case report. Surg Case Rep 2024; 10:142. [PMID: 38864981 PMCID: PMC11169172 DOI: 10.1186/s40792-024-01941-7] [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: 03/19/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Following the rupture of a coronary artery, a patient's condition usually deteriorates rapidly due to cardiac tamponade. A pseudoaneurysm due to a coronary artery rupture is rare; however, when a spontaneous coronary artery pseudoaneurysm occurs without tamponade, it creates a fistula in the right ventricle, often requiring surgical repair. CASE PRESENTATION This report describes the case of a 68-year-old man who presented with chest discomfort after a 12-day course of antibiotic treatment for bacteremia. Following coronary angiography, echocardiography, and enhanced computed tomography, he was diagnosed with a right coronary artery pseudoaneurysm accompanied with perforation of the right ventricle. Severe adhesions were observed during emergency surgery surrounding the entire heart. The patient presented with risk factors for coronary artery disease, including hypertension and smoking history. His coronary artery was severely calcified due to end-stage renal failure requiring dialysis; thus, a covered stent could not fit inside the arterial lumen. Consequently, coronary artery bypass grafting to the right coronary artery and right ventricle repair were performed. Unfortunately, the patient died postoperatively due to sepsis from intestinal translocation. This rare development was hypothesized to be an incidental result of the combination of severe post-inflammatory adhesions, extensive coronary artery calcification, and rupture of the calcification crevices. CONCLUSIONS In the case of a severe post-inflammatory response, shock without cardiac tamponade may require further scrutiny by assuming the possibility of inward rupture. For patients in poor condition, two-stage surgical treatment might be considered after stabilization with a covered stent.
Collapse
Affiliation(s)
- Masato Furui
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan.
| | - Hitoshi Matsumura
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Yoshio Hayashida
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Go Kuwahara
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Masayuki Shimizu
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Yuichi Morita
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Yuta Matsuoka
- Emergency Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Chihaya Ito
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Masato Hayama
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Kayo Wakamatsu
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Hideichi Wada
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| |
Collapse
|
2
|
Wang C, Han B, Hu W, Lin R. The giant coronary pseudoaneurysm misdiagnosed as a mediastinal mass: A rare case report. Asian J Surg 2022; 45:2846-2847. [PMID: 35753921 DOI: 10.1016/j.asjsur.2022.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Chenhan Wang
- The First Clinical Medical College of Lanzhou University, No.199 Donggang West Road, Lanzhou, 730000, Gansu, China
| | - Biao Han
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Lanzhou, 730000, Gansu, China.
| | - Wenteng Hu
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Lanzhou, 730000, Gansu, China
| | - Ruijiang Lin
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, No.1 Donggang West Road, Lanzhou, 730000, Gansu, China
| |
Collapse
|
3
|
Kar S, Webel RR. Diagnosis and treatment of spontaneous coronary artery pseudoaneurysm: Rare anomaly with potentially significant clinical implications. Catheter Cardiovasc Interv 2017; 90:589-597. [PMID: 28258964 DOI: 10.1002/ccd.26997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/17/2017] [Accepted: 01/28/2017] [Indexed: 12/20/2022]
Abstract
Spontaneous coronary artery pseudoaneurysm (PSA, false aneurysm) is an extremely rare occurrence with the precise incidence unknown. It is defined as an outwardly bulging monolayer or double layer within the coronary artery that lacks all 3 layers (intima, media, and adventitia) of the arterial wall. Coronary PSA commonly occurs from arterial dissection or perforation induced by catheter intervention, infection, pregnancy, or trauma. Traumatic dissection or perforation of the coronary artery after a percutaneous coronary intervention (PCI) remains the most common cause. Such cases may progress to myocardial ischemia, acute myocardial infarction, or acute coronary artery rupture causing death from cardiac tamponade. Intravascular ultrasound or cardiac computed tomography may aid in the diagnosis. Treatment options include PCI with a covered stent, bare or drug-eluting stent, coil embolization, coronary artery bypass graft with isolation of the PSA, or conservative management with vigilant clinical follow-up. In this review, we sought to describe the diagnosis, etiology, treatment, and the limited literature on spontaneous coronary artery PSA. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Subrata Kar
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas
| | - Richard R Webel
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri
| |
Collapse
|