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Halyckyj-Smith J, Rose D. Resection of a giant right coronary artery aneurysm and reconstruction with a saphenous vein graft: a 20-year follow-up-case report. Eur Heart J Case Rep 2024; 8:ytae357. [PMID: 39381327 PMCID: PMC11458912 DOI: 10.1093/ehjcr/ytae357] [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: 12/09/2023] [Revised: 04/03/2024] [Accepted: 07/17/2024] [Indexed: 10/10/2024]
Abstract
Background Coronary artery aneurysms (CAAs) are uncommon and can cause complications such as thrombosis, vessel rupture, or distal embolization. Rarely, CAAs are classified as 'giant', although the defining diameter is debated. The predominant cause of CAAs is atherosclerotic disease. Independently, CAAs constitute an estimated 5-year survival of 71%. Case summary We report the case of a 56-year-old female who presented 20 years ago with a chest infection when a murmur was auscultated on examination. Subsequently, a coronary angiogram was performed, demonstrating an extensive aneurysm of the right coronary artery (RCA). The aneurysmal segment of the RCA was resected, and a length of saphenous vein was utilized in its reconstruction. Twenty years later, the patient re-presented with dyspnoea, indicating repeat investigations; coronary angiography demonstrated a vein graft 20 years post-reconstruction that is almost indistinguishable from a native RCA. Discussion The optimal management strategy for CAAs is debatable, and there are no clear guidelines. However, surgical management is generally preferred in cases of GCAAs, which was also the case for this patient. This reconstruction procedure, involving resection of the aneurysmal segment of the RCA and reconstruction with a saphenous vein graft, proved to be a durable and reliable approach, with the saphenous vein graft remaining patent for over 20 years. The 20-year follow-up provides valuable insight into the long-term durability of surgical intervention, allowing for comprehensive assessment of the durability and reliability of this procedure.
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Affiliation(s)
- Joshua Halyckyj-Smith
- University of Manchester, Royal Preston Hospital, Lancashire Teaching Hospitals Trust, Sharoe Green Ln, Fulwood, Preston PR2 9HT, UK
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Whinney Heys Rd, Blackpool FY3 8NP, UK
| | - David Rose
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Whinney Heys Rd, Blackpool FY3 8NP, UK
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Chandrasekhar S, Woods E, Bennett J, Newman N, McLean P, Alam M, Jneid H, Sharma S, Khawaja M, Krittanawong C. Coronary Artery Anomalies: Diagnosis & Management. Cardiol Rev 2024:00045415-990000000-00334. [PMID: 39315746 DOI: 10.1097/crd.0000000000000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Coronary artery anomalies encompass a spectrum of congenital abnormalities affecting the origin, course, or termination of the major epicardial coronary arteries. Despite their rarity, coronary artery anomalies represent a significant burden on cardiovascular health due to their potential to disrupt myocardial blood flow and precipitate adverse cardiac events. While historically diagnosed postmortem, the widespread availability of imaging modalities has led to an increased recognition of coronary artery anomalies, particularly in adults. This review synthesizes current knowledge on the classification, mechanisms, and clinical implications of coronary anomalies, focusing on prevalent variants with significant clinical impact. We discuss strategies for medical and surgical management, as well as contemporary screening recommendations, acknowledging the evolving understanding of these anomalies. Given the breadth of possible variants and the limited data on some presentations, this review provides a framework to aid clinicians in the recognition and management of coronary anomalies, with a particular emphasis on their stratification by anatomical location. By consolidating existing knowledge and highlighting areas of uncertainty, this review aims to enhance clinical decision-making and improve outcomes for individuals with coronary anomalies.
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Affiliation(s)
- Sanjay Chandrasekhar
- From the Division of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Edward Woods
- From the Division of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Josiah Bennett
- From the Division of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Noah Newman
- From the Division of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Patrick McLean
- From the Division of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Mahboob Alam
- Cardiology Division, The Texas Heart Institute, Baylor College of Medicine, Houston, TX
| | - Hani Jneid
- John Sealy Distinguished Centennial Chair in Cardiology, Chief, Division of Cardiology, University of Texas Medical Branch, Houston, TX
| | - Samin Sharma
- Department of Cardiology, Mount Sinai Hospital, New York, NY
| | - Muzamil Khawaja
- Cardiology Division, Emory University School of Medicine, Atlanta, GA
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Woźniak P, Iwańczyk S, Błaszyk M, Stępień K, Lesiak M, Mularek-Kubzdela T, Araszkiewicz A. Coronary Artery Aneurysm or Ectasia as a Form of Coronary Artery Remodeling: Etiology, Pathogenesis, Diagnostics, Complications, and Treatment. Biomedicines 2024; 12:1984. [PMID: 39335497 PMCID: PMC11428638 DOI: 10.3390/biomedicines12091984] [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: 07/17/2024] [Revised: 08/19/2024] [Accepted: 08/29/2024] [Indexed: 09/30/2024] Open
Abstract
Coronary artery aneurysm or ectasia (CAAE) is a term that includes both coronary artery ectasia (CAE) and coronary artery aneurysm (CAA), despite distinct phenotypes and definitions. This anomaly can be found in 0.15-5.3% of coronary angiography. CAE is a diffuse dilatation of the coronary artery at least 1.5 times wider than the diameter of the normal coronary artery in a patient with a length of over 20 mm or greater than one-third of the vessel. CAE can be further subdivided into diffuse and focal dilations by the number and the length of the dilated vessels. Histologically, it presents with extensive destruction of musculoelastic elements, marked degradation of collagen and elastic fibers, and disruption of the elastic lamina. Conversely, CAA is a focal lesion manifesting as focal dilatation, which can be fusiform (if the longitudinal diameter is greater than the transverse) or saccular (if the longitudinal diameter is smaller than the transverse). Giant CAA is defined as a 4-fold enlargement of the vessel diameter and is observed in only 0.02% of patients after coronary. An aneurysmal lesion can be either single or multiple. It can be either a congenital or acquired phenomenon. The pathophysiological mechanisms responsible for the formation of CAAE are not well understood. Atherosclerosis is the most common etiology of CAAE in adults, while Kawasaki disease is the most common in children. Other etiological factors include systemic connective tissue diseases, infectious diseases, vasculitis, congenital anomalies, genetic factors, and idiopathic CAA. Invasive assessment of CAAE is based on coronary angiography. Coronary computed tomography (CT) is a noninvasive method that enables accurate evaluation of aneurysm size and location. The most common complications are coronary spasm, local thrombosis, distal embolization, coronary artery rupture, and compression of adjacent structures by giant coronary aneurysms. The approach to each patient with CAAE should depend on the severity of symptoms, anatomical structure, size, and location of the aneurysm. Treatment methods should be carefully considered to avoid possible complications of CAAE. Simultaneously, we should not unnecessarily expose the patient to the risk of intervention or surgical treatment. Patients can be offered conservative or invasive treatment. However, there are still numerous controversies and ambiguities regarding the etiology, prognosis, and treatment of patients with coronary artery aneurysms. This study summarizes the current knowledge about this disease's etiology, pathogenesis, and management.
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Affiliation(s)
- Patrycja Woźniak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznań, Poland
| | - Sylwia Iwańczyk
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznań, Poland
| | - Maciej Błaszyk
- Department of Radiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Konrad Stępień
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Prądnicka 80 Street, 31-202 Kraków, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznań, Poland
| | - Tatiana Mularek-Kubzdela
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznań, Poland
| | - Aleksander Araszkiewicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznań, Poland
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4
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Dimagli A, Malas J, Chen S, Sandner S, Schwann T, Tatoulis J, Puskas J, Bowdish ME, Gaudino M. Coronary Artery Aneurysms, Arteriovenous Malformations, and Spontaneous Dissections-A Review of the Evidence. Ann Thorac Surg 2024; 117:887-896. [PMID: 38081498 DOI: 10.1016/j.athoracsur.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Coronary artery aneurysms (CAAs), coronary arteriovenous malformations (CAVMs), and spontaneous coronary artery dissections (SCADs) are rare clinical entities, and much is unknown about their natural history, prognosis, and management. METHODS A systematic search of MEDLINE, Embase, and Cochrane Library databases was performed in March 2023 to identify published papers related to CAAs, CAVMs, and SCADs. RESULTS CAAs are found in 0.3% to 12% of patients undergoing angiography and are often associated with coronary atherosclerosis. They are usually asymptomatic but can be complicated by thrombosis in up to 4.8% of patients and rarely by rupture (0.2%). CAAs can be managed medically, percutaneously with stents or coil embolization, and surgically. The most common surgical procedure is ligation of the aneurysm, followed by coronary artery bypass grafting. The incidence of CAVMs is 0.1% to 0.2% in patients undergoing angiography, and they are most likely associated with congenital abnormal development of the coronary vessels. The diagnosis of CAVMs is usually incidental. Surgical or percutaneous intervention is indicated for patients with large CAVMs, which carry a potential risk of myocardial infarction. SCADs represent 1% to 4% of all acute coronary syndromes and typically affect young women. SCADs are strongly correlated with pregnancy, suggesting the role of sex hormones in their pathogenesis. Conservative management of SCAD is preferred for stable patients without signs of ischemia as spontaneous resolution is frequently reported. Unstable patients should undergo revascularization either percutaneously or with coronary artery bypass grafting. CONCLUSIONS Further evidence regarding the management of these rare diseases is needed and can ideally be derived from multicenter collaborations.
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Affiliation(s)
- Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Jad Malas
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sarah Chen
- Division of Cardiac Surgery, University of California Davis Health, Sacramento, California
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schwann
- Department of Surgery, University of Massachusetts-Baystate, Springfield, Massachusetts
| | - James Tatoulis
- The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, New York
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
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Prathivadhi-Bhayankaram S, Ashwath ML. A case report of a giant coronary artery aneurysm masquerading as a ventricular mass. Eur Heart J Case Rep 2024; 8:ytae124. [PMID: 38572017 PMCID: PMC10990057 DOI: 10.1093/ehjcr/ytae124] [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] [Received: 10/16/2023] [Revised: 02/19/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
Background A coronary artery aneurysm is a dilation exceeding 1.5 times the diameter of the patient's largest coronary vessel. They are rare, varying in prevalence between 1.4 and 4.9%. Additionally, they carry a high risk of potential complications, including thrombosis and myocardial infarction, with a risk of rupture. We present an interesting case of a patient with initial imaging suggesting a mass in the right ventricle. Case summary This patient initially presented with acute hypoxic respiratory failure related to pulmonary oedema. His course was complicated by symptomatic ventricular tachycardia and an inferoposterior myocardial infarction. Further investigation revealed a left anterior descending artery and circumflex artery thrombosed aneurysm projecting into the right ventricle. Multimodal imaging was used to arrive at his diagnosis. He continues to do well on medical therapy for coronary artery disease and heart failure. Discussion Clinicians should be vigilant for this rare pathology, which may be easily missed yet poses a high mortality risk. Our case demonstrates the benefit of multimodal imaging, as this patient's aneurysm was initially mistaken for a ventricular mass.
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Affiliation(s)
- Sruti Prathivadhi-Bhayankaram
- Department of Internal Medicine, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Mahi L Ashwath
- Department of Internal Medicine, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
- Heart and Vascular Center, Department of Internal Medicine, University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Khan Z. A Young Patient With Acute Ostial Right Coronary Artery Aneurysm Presenting As ST Elevation Myocardial Infarction. Cureus 2024; 16:e58063. [PMID: 38741823 PMCID: PMC11090374 DOI: 10.7759/cureus.58063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
A coronary artery aneurysm (CAA) is a localized dilatation of a coronary artery segment >1.5 times the diameter of the adjacent normal segment. CAA is more common in men than women and has multiple etiologies, including genetic causes, infections, and atherosclerotic diseases. Kawasaki disease is the most common cause of CAA in children, whereas atherosclerosis is the most common etiology in adults. We present the case of a male in his 30s who presented with sudden-onset chest pain and inferior ST segment elevation on an ECG. Echocardiography revealed preserved left ventricular function and mild hypokinesia. The patient underwent an emergency coronary angiogram that showed an ostial right CAA with thrombi. He was initially managed with a glycoprotein IIb/IIIa inhibitor tirofiban infusion, followed by triple therapy with aspirin, clopidogrel, and rivaroxaban. The patient underwent magnetic resonance imaging of his head, which was normal, and he did not attend outpatient computed tomography coronary angiography. The patient was discharged with lifelong rivaroxaban 20 mg once daily.
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Affiliation(s)
- Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
- Cardiology, Barts Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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7
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Zayour M, Toufayli HY, Masri NW, Terro S, Chammas E. Coronary Artery Aneurysm: Its Evaluation in a 27-Year-Old Female Patient, Prognosis, and Suggested Treatment Strategies. Cureus 2023; 15:e47010. [PMID: 37965398 PMCID: PMC10642623 DOI: 10.7759/cureus.47010] [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] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Coronary artery aneurysm (CAA) is characterized by a localized dilation of one or more of the coronary arteries with multiple etiologies, including congenital, acquired, or connected to auto-inflammatory diseases with multiple shapes and classifications. It is usually diagnosed incidentally during coronary imaging and can have variable clinical outcomes, ranging from asymptomatic to sudden cardiac death with a generally poor prognosis. Management of this condition faces a clinical dilemma due to the lack of clear guidelines or randomized trials. Treatment should be individualized based on symptoms, shape, and comorbidities. Herein, we present the case report of a 27-year-old female patient with no prior medical conditions. However, she presented with palpitations, and a compressive mass located over the right atrium was identified in the patient. After undergoing cardiac catheterization and coronary scanning, a giant aneurysm of the sinoatrial branch was detected with an aneurysmal left main that was retrieved surgically with good recovery and postoperative course.
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Affiliation(s)
| | | | | | - Samer Terro
- Cardiology, Clemeceau Medical Center, Beirut, LBN
| | - Elie Chammas
- Cardiology, Clemeceau Medical Center, Beirut, LBN
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Lionakis N, Briasoulis A, Zouganeli V, Koutoulakis E, Kalpakos D, Xanthopoulos A, Skoularigis J, Kourek C. Coronary artery aneurysms: Comprehensive review and a case report of a left main coronary artery aneurysm. Curr Probl Cardiol 2023; 48:101700. [PMID: 36931332 DOI: 10.1016/j.cpcardiol.2023.101700] [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: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
Coronary artery aneurysms (CAAs) are rare anatomical disorders of the coronary arteries. Atherosclerosis and Kawasaki disease are the principal causes of CCAs, while other causes including genetic factors, inflammatory arterial diseases, connective tissue disorders, endothelial damage after cocaine use, iatrogenic complications after interventions and infections, are also common among patients with CAAs. Although there is a variety of non-invasive methods including echocardiography, computed tomography, and magnetic resonance imaging, coronary angiography remains the gold standard diagnostic method. There is still no consensus about the most appropriate therapeutic strategy. Medical therapy including antiplatelets, anticoagulants, statins and ACEs are preferred either in patients with atherosclerosis, inflammatory status and stable CAAs, while percutaneous or surgery interventions are usually applied in patients with acute coronary syndrome due to a CAA culprit, obstructive coronary artery disease or large saccular aneurysms at a high risk of rupturing.
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Affiliation(s)
- Nikolaos Lionakis
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, Alexandra Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece; Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa Hospitals and Clinics, IA 52242, United States
| | - Virginia Zouganeli
- Second Cardiology Department, Attikon University Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Emmanouil Koutoulakis
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Dionisios Kalpakos
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Christos Kourek
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece.
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Holvoet W, van den Buijs D, Bogaerts E, Willems E, Ameloot K, Dens J. Giant coronary artery aneurysm of the left main treated with a covered stent: a case report. Eur Heart J Case Rep 2023; 7:ytac463. [PMID: 36865654 PMCID: PMC9972523 DOI: 10.1093/ehjcr/ytac463] [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] [Received: 03/06/2022] [Revised: 05/04/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
Background Coronary artery aneurysms (CAAs) of the left main represent a small subset of coronary artery disease and are associated with cardiovascular death. Because of its rare entity, large data are lacking and therefore treatment guidelines are missing. Case summary We describe a case of a 56-year-old female with a past medical history of spontaneous dissection of the distal descending left artery (LAD) 6 years before. She presented to our hospital with a non-ST elevation myocardial infarction and a coronary angiogram showed a giant saccular aneurysm of the shaft of the left main coronary artery (LMCA). Given the risk of rupture and distal embolization, the heart team decided to go for a percutaneous approach. Based on a pre-interventional 3D reconstructed CT scan and guided by intravascular ultrasound, the aneurysm was successfully excluded with a 5 mm papyrus-covered stent. At 3-month and 1-year follow-up, the patient is still asymptomatic and repeat angiographies showed full exclusion of the aneurysm and the absence of restenosis in the covered stent. Discussion We describe the successful percutaneous IVUS-guided treatment of a giant LMCA shaft coronary aneurysm with a papyrus-covered stent with an excellent 1-year angiographic follow-up showing no residual filling of the aneurysm and no stent restenosis.
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Affiliation(s)
- Wouter Holvoet
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (ZOL), Schiepse Bos 6, 3600 Genk, Belgium
| | - Deborah van den Buijs
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (ZOL), Schiepse Bos 6, 3600 Genk, Belgium
| | - Eline Bogaerts
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (ZOL), Schiepse Bos 6, 3600 Genk, Belgium
| | - Endry Willems
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk (ZOL), Schiepse Bos 6, 3600 Genk, Belgium
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (ZOL), Schiepse Bos 6, 3600 Genk, Belgium
| | - Jo Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk (ZOL), Schiepse Bos 6, 3600 Genk, Belgium
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Roberts WC. Case reports by William C. Roberts, MD, and colleagues (1961–2022). Proc AMIA Symp 2022; 35:879-888. [DOI: 10.1080/08998280.2022.2114130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- William C. Roberts
- Baylor Heart and Vascular Institute and Departments of Pathology and Internal Medicine, Baylor University Medical Center, Dallas, Texas
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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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12
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Shah MA, Alqahtani A, Alshahrani ST, Alshehri HZ. Giant coronary artery aneurysm associated with familial retinal artery macroaneurysm: a case report. Eur Heart J Case Rep 2022; 6:ytac057. [PMID: 35299703 PMCID: PMC8922714 DOI: 10.1093/ehjcr/ytac057] [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] [Received: 09/14/2021] [Revised: 10/19/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The term 'Giant' coronary aneurysm is usually defined as any coronary aneurysm more than 8 mm in maximum diameter. The form of familial retinal arterial macroaneurysms (FRAMs) is a rare autosomal recessive disease that is described by arterial aneurysm formation in the retina. Here, we report an association of coronary artery aneurysms with FRAM in a young male who presented with the acute coronary syndrome. CASE SUMMARY A 31-year-old male smoker presented to the emergency department with atypical chest pain for 5 days. Blood investigations showed raised troponin enzymes. Review of his past medical history revealed decreased vision in the left eye, starting at the age of 10 years which progressed to blindness. He was diagnosed to have IGFBP7 mutation which causes eye manifestations in the form of FRAM. Fundoscopy showed bleeding retinal artery macroaneurysms in the right retina and sub-retinal gliosis suggesting laser treatment for the prior retinal arterial aneurysm. Coronary angiogram revealed a large aneurysm in the proximal segment of the left anterior descending (LAD) artery. Cardiac computed tomography scan with contrast was done which showed a 2.28 × 1.64 cm coronary aneurysm at the proximal segment of the LAD artery with peripheral calcification with a narrow neck of about 0.6 cm. After the heart team discussion, he underwent surgical ligation of the LAD and coronary aneurysm with implantation of the saphenous venous graft to distal LAD. DISCUSSION Coronary artery aneurysms can be a part of multisystem diseases like FRAM. The management should be individualized based on symptoms at presentation, size of coronary aneurysms, and local expertise.
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Affiliation(s)
- Muhammad Azam Shah
- King Fahad Medical City, Dabab Street, Sulaimaniya, PO Box 221124, 11311 Riyadh, Saudi Arabia
| | - Abdulrahman Alqahtani
- King Fahad Medical City, Dabab Street, Sulaimaniya, PO Box 221124, 11311 Riyadh, Saudi Arabia
| | - Saeed T Alshahrani
- King Fahad Medical City, Dabab Street, Sulaimaniya, PO Box 221124, 11311 Riyadh, Saudi Arabia
| | - Halia Zain Alshehri
- King Fahad Medical City, Dabab Street, Sulaimaniya, PO Box 221124, 11311 Riyadh, Saudi Arabia
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13
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Navarro-Zambrano G, Martínez-Hernández H, Mero-Vélez R, Castillo Castellón F. Abordaje quirúrgico para un aneurisma gigante de la arteria coronaria izquierda: caso clínico. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Gori T. Coronary Vasculitis. Biomedicines 2021; 9:biomedicines9060622. [PMID: 34072772 PMCID: PMC8226826 DOI: 10.3390/biomedicines9060622] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/23/2021] [Accepted: 05/28/2021] [Indexed: 02/06/2023] Open
Abstract
The term coronary “artery vasculitis” is used for a diverse group of diseases with a wide spectrum of manifestations and severity. Clinical manifestations may include pericarditis or myocarditis due to involvement of the coronary microvasculature, stenosis, aneurysm, or spontaneous dissection of large coronaries, or vascular thrombosis. As compared to common atherosclerosis, patients with coronary artery vasculitis are younger and often have a more rapid disease progression. Several clinical entities have been associated with coronary artery vasculitis, including Kawasaki’s disease, Takayasu’s arteritis, polyarteritis nodosa, ANCA-associated vasculitis, giant-cell arteritis, and more recently a Kawasaki-like syndrome associated with SARS-COV-2 infection. This review will provide a short description of these conditions, their diagnosis and therapy for use by the practicing cardiologist.
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Affiliation(s)
- Tommaso Gori
- Kardiologie I and DZHK Standort Rhein-Main, Universitätsmedizin Mainz, 55131 Mainz, Germany
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15
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Khanna S, Garikapati K, Goh DSL, Cho K, Lo P, Bhojaraja MV, Tarafdar S. Coronary artery vasculitis: a review of current literature. BMC Cardiovasc Disord 2021; 21:7. [PMID: 33407141 PMCID: PMC7788693 DOI: 10.1186/s12872-020-01813-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiac vasculitis is recognized as a heterogeneous disease process with a wide spectrum of manifestations including pericarditis, myocarditis, valvular heart disease and less frequently, coronary artery vasculitis (CAV). CAV encompasses an emerging field of diseases which differ from conventional atherosclerotic disease and have a proclivity for the younger population groups. CAV portends multiple complications including the development of coronary artery aneurysms, coronary stenotic lesions, and thrombosis, all which may result in acute coronary syndromes. There are several aetiologies for CAV; with Kawasaki's disease, Takayasu's arteritis, Polyarteritis Nodosa, and Giant-Cell Arteritis more frequently described clinically, and in literature. There is a growing role for multi-modality imaging in assisting the diagnostic process; including transthoracic echocardiography, cardiac magnetic resonance imaging, computed tomography coronary angiography, fluorodeoxyglucose-positron emission tomography and conventional coronary angiogram with intravascular ultrasound. Whilst the treatment paradigms fundamentally vary between different aetiologies, there are overlaps with pharmacological regimes in immunosuppressive agents and anti-platelet therapies. Interventional and surgical management are is a consideration in select populations groups, within a multi-disciplinary context. Further large-scale studies are required to better appropriately outline management protocols in this niche population.
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Affiliation(s)
- Shaun Khanna
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.
| | - Kartheek Garikapati
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Daniel S L Goh
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Kenneth Cho
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | - Phillip Lo
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia
| | | | - Surjit Tarafdar
- Department of Medicine, Blacktown Hospital, 18 Blacktown Road, Blacktown, NSW, 2148, Australia.,Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia
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16
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Percutaneous Coronary Intervention in Coronary Artery Aneurysms; Technical Aspects. Report of Case Series and Literature Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28S:243-248. [PMID: 33323331 DOI: 10.1016/j.carrev.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/15/2020] [Accepted: 12/04/2020] [Indexed: 12/20/2022]
Abstract
Coronary Artery Aneurysms (CAAs) in both symptomatic and asymptomatic patients are associated with poor long-term outcomes. The best treatment option for CAAs remains a subject of debate. The underlying pathology is not well understood, randomised controlled trials and supportive data are lacking and there is no consensus on treatment plan. The recommended therapies include medical management, percutaneous or surgical exclusion of the aneurysm or coronary artery bypass grafting surgery (CABG). Percutaneous coronary intervention (PCI) can be technically challenging even with a suitable anatomy, specifically in acute coronary syndrome (ACS). We report case series of CAAs presenting as ACS and focus on PCI treatment option.
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17
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Percutaneous Intervention of Coronary Aneurysm. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:138-142. [DOI: 10.1016/j.carrev.2019.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/11/2019] [Accepted: 08/12/2019] [Indexed: 11/22/2022]
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18
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Carino D, Agarwal A, Singh M, Meadows J, Ziganshin BA, Elefteriades JA. Coronary Aneurysm: An Enigma Wrapped in a Mystery. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2019; 7:71-74. [PMID: 31614375 PMCID: PMC6794143 DOI: 10.1055/s-0039-1688467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Coronary aneurysms are defined as localized dilatations of the coronary arteries. In this review, we will analyze the most important aspects of this rare condition while trying to provide answers to the following questions: What is a coronary aneurysm? What causes coronary aneurysm? Do coronary aneurysms cause symptoms? Can coronary aneurysms rupture? How do we treat coronary aneurysms?
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Affiliation(s)
- Davide Carino
- Aortic Institute, Yale-New Haven Hospital, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Arvind Agarwal
- Aortic Institute, Yale-New Haven Hospital, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Mrinal Singh
- Aortic Institute, Yale-New Haven Hospital, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Judith Meadows
- Aortic Institute, Yale-New Haven Hospital, Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Radiology, Yale-New Haven Hospital, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Bulat A Ziganshin
- Aortic Institute, Yale-New Haven Hospital, Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- Aortic Institute, Yale-New Haven Hospital, Yale School of Medicine, Yale University, New Haven, Connecticut
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19
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De Hous N, Haine S, Oortman R, Laga S. Alternative Approach for the Surgical Treatment of Left Main Coronary Artery Aneurysm. Ann Thorac Surg 2019; 108:e91-e93. [DOI: 10.1016/j.athoracsur.2018.12.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
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20
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Bath A, Shaikh F, Kalavakunta JK. Coronary artery aneurysm presenting as STEMI. BMJ Case Rep 2019; 12:12/6/e231013. [PMID: 31229968 DOI: 10.1136/bcr-2019-231013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anandbir Bath
- Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Faizan Shaikh
- Department of Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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21
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Liu J, Wang X, Sun D, Yang J. Dual Aneurysms of the Left Anterior Descending Coronary Artery Initially Detected by Echocardiography. Int Heart J 2019; 60:778-783. [PMID: 31019166 DOI: 10.1536/ihj.18-401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Echocardiographic detection of abnormalities occurring medially and distally in coronary arteries is uncommon and is not well recognized. Herein, we describe an 87-year-old woman with two distinct aneurysms involving a branch of the left anterior descending coronary artery (LAD), one of which communicated with the pulmonary artery (PA). Initially determined via transthoracic echocardiography (TTE), these findings were subsequently validated by coronary computed tomography angiography (CTA). We also present a review of the published studies of multiple coronary artery aneurysms (CAAs) exceeding 20 mm in diameter, focusing on the location, etiology, symptoms, and common ultrasonic characteristics of 30 cases. Echocardiography is a valuable, noninvasive technique for initial detection, monitoring, and follow-up of CAAs, serving to direct further diagnostics.
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Affiliation(s)
- Juanjuan Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University
| | - Xiaobing Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University
| | - Dandan Sun
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University
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22
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Roldan LP, Rowan C, Sheldon M, Roldan CA. Three-vessel coronary artery aneurysmal disease complicated by multivessel thrombosis and cardiogenic shock: the saving role of intracoronary thrombolysis. BMJ Case Rep 2017; 2017:bcr-2017-222038. [PMID: 29248881 DOI: 10.1136/bcr-2017-222038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The benefit of intracoronary thrombolytics in ST-elevation myocardial infarction (STEMI) is not well established. Mainstays of STEMI management include intravenous thrombolytics, percutaneous coronary interventions and surgical revascularisation. However, in cases of STEMI secondary to coronary artery aneurysmal disease (CAAD), standard treatment options may not be suitable due to high thrombus burden, perioperative risk and factors unique to each patient. Thus, STEMI management in CAAD can represent a therapeutically challenging clinical scenario. Here, we describe a patient with severe three-vessel CAAD complicated by multivessel thrombosis and cardiogenic shock for whom traditional management options including placement of haemodynamic support devices were not feasible. As an alternative measure, the patient was treated with intracoronary thrombolysis with remarkable clinical stabilisation and angiographic resolution of thrombosis. He remains clinically stable several years later without recurrent events. This case serves to demonstrate the potential lifesaving benefit of intracoronary thrombolysis in complicated multivessel CAAD.
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Affiliation(s)
- Luis Pablo Roldan
- Department of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Chris Rowan
- University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Mark Sheldon
- Department of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Carlos A Roldan
- Department of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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23
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Abstract
Aneurysmal coronary artery disease (ACAD) comprises both coronary artery aneurysms (CAA) and coronary artery ectasia (CAE). The reported prevalence of ACAD varies widely from 0.2 to 10%, with male predominance and a predilection for the right coronary artery (RCA). Atherosclerosis is the commonest cause of ACAD in adults, while Kawasaki disease is the commonest cause in children and adolescents, as well as in the Far East. Most patients are asymptomatic, but when symptoms do exist, they are usually related to myocardial ischemia. Coronary angiography is the mainstay of diagnosis, but follow up is best achieved using noninvasive imaging that does not involve exposure to radiation. The optimal management strategy in patients with ACAD remains controversial. Medical therapy is indicated for the vast majority of patients and includes antiplatelets and/or anticoagulants. Covered stents effectively limit further expansion of the affected coronary segments. Surgical ligation, resection, and coronary artery bypass grafting are appropriate for large lesions and for associated obstructive coronary artery disease.
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Affiliation(s)
| | - Ahmed M ElGuindy
- Department of Cardiology, Aswan Heart Centre, Egypt.,Imperial College London, UK
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24
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Latt H, Aung S, Kyaw K, Seher R. Coronary artery ectasia presenting with acute inferior wall myocardial infarction in a young adult. J Community Hosp Intern Med Perspect 2017; 7:262-264. [PMID: 29046758 PMCID: PMC5637702 DOI: 10.1080/20009666.2017.1369376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 08/10/2017] [Indexed: 12/03/2022] Open
Abstract
Coronary artery ectasia (CAE), a variant of coronary artery anomalies, is a rare clinical entity. Although atherosclerotic coronary artery disease (CAD) is the most common cause of acute coronary syndrome (ACS), CAE also conveys a relatively high risk for potentially life-threatening cardiac events. We report a case of a 35-year-old male with two-vessel CAE, who presented with acute inferior wall ST election myocardial infarction (STEMI). After initiating medical therapy including bivalirudin, emergent percutaneous coronary intervention (PCI) with stenting of postero-lateral branch of right coronary artery (RCA) was performed. Coronary angiography also showed diffuse ectasia of RCA and left anterior descending artery (LAD). The patient tolerated the procedure well and was discharged on appropriate medical therapy. He was followed-up at one month, with no resulting cardiac events. This case highlights the importance of CAE awareness. CAE has drawn the attention of clinicians because of its clinical implications, as well as its seemingly higher prevalence, due to the abundant use of coronary angiograms and advanced cardiac imaging in the contemporary world. Albeit there has been much progress in the understanding and management of the disease, questions still remain regarding the exact pathophysiology, management guidelines and prognosis of CAE, which are worth further study.
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Affiliation(s)
- Htun Latt
- Department of Internal Medicine, University of Nevada - Reno, School of Medicine, Reno, Nevada, USA
| | - Sammy Aung
- Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, Nevada, USA
| | - Kyaw Kyaw
- Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, Nevada, USA
| | - Richard Seher
- Institute for Heart and Vascular Health, Renown Regional Medical Center, Reno, Nevada, USA
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25
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Giant coronary aneurysm management with Viabahn covered stent. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:56-59. [DOI: 10.1016/j.carrev.2017.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/21/2017] [Indexed: 11/18/2022]
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26
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Kondapalli N, Roberts WC. Coronary arterial aneurysms in previously transplanted (donor) hearts. Proc (Bayl Univ Med Cent) 2017; 30:303-304. [PMID: 28670064 DOI: 10.1080/08998280.2017.11929623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Described herein is a 57-year-old man who had had a cardiac transplant 5 years earlier (at age 52) and died of a ruptured abdominal aortic aneurysm. The donor heart was found to have a fusiform aneurysm, each filled with thrombus, in 2 major epicardial coronary arteries.
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Affiliation(s)
- Nitin Kondapalli
- Baylor Heart and Vascular Institute and the Departments of Internal Medicine (Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas
| | - William C Roberts
- Baylor Heart and Vascular Institute and the Departments of Internal Medicine (Cardiology) and Pathology, Baylor University Medical Center, Dallas, Texas
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27
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Vasu N, Narayanan S, Ajit MS. Clinical outcome of various management strategies in coronary artery ectasia. Indian Heart J 2017. [PMID: 28648421 PMCID: PMC5485435 DOI: 10.1016/j.ihj.2017.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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28
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Kilic ID, Fabris E, Serdoz R, Caiazzo G, Foin N, Abou-Sherif S, Di Mario C. Coronary covered stents. EUROINTERVENTION 2017; 12:1288-1295. [PMID: 27866138 DOI: 10.4244/eijv12i10a210] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Covered stents offer an effective bail-out strategy in vessel perforations, are an alternative to surgery for the exclusion of coronary aneurysms, and have a potential role in the treatment of friable embolisation-prone plaques. The aim of this manuscript is to offer an overview of currently available platforms and to report results obtained in prior studies.
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Affiliation(s)
- Ismail Dogu Kilic
- The NIHR Cardiovascular BRU, Royal Brompton Hospital & NHLI Imperial College, London, United Kingdom
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29
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Abou Sherif S, Ozden Tok O, Taşköylü Ö, Goktekin O, Kilic ID. Coronary Artery Aneurysms: A Review of the Epidemiology, Pathophysiology, Diagnosis, and Treatment. Front Cardiovasc Med 2017; 4:24. [PMID: 28529940 PMCID: PMC5418231 DOI: 10.3389/fcvm.2017.00024] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 04/07/2017] [Indexed: 12/11/2022] Open
Abstract
Coronary artery aneurysms (CAAs) are uncommon and describe a localized dilatation of a coronary artery segment more than 1.5-fold compared with adjacent normal segments. The incidence of CAAs varies from 0.3 to 5.3%. Ever since the dawn of the interventional era, CAAs have been increasingly diagnosed on coronary angiography. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease (KD), and percutaneous coronary intervention. The natural history of CAAs remains unclear; however, several recent studies have postulated the underlying molecular mechanisms of CAAs, and genome-wide association studies have revealed several genetic predispositions to CAA. Controversies persist regarding the management of CAAs, and emerging findings support the importance of an early diagnosis in patients predisposed to CAAs, such as in children with KD. This review aims to summarize the present knowledge of CAAs and collate the recent advances regarding the epidemiology, etiology, pathophysiology, diagnosis, and treatment of this disease.
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Affiliation(s)
- Sara Abou Sherif
- Cardiovascular Research Division, Kings College London, London, UK
| | - Ozge Ozden Tok
- Department of Cardiology, Memorial Hospital, Istanbul, Turkey
| | | | - Omer Goktekin
- Department of Cardiology, Memorial Hospital, Istanbul, Turkey
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30
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Bhamidipati CM, McCabe JM, Jones TK, Lombardi WL, Reisman M, Pal JD. Hybrid Management of a Giant Left Main Coronary Artery Aneurysm. Ann Thorac Surg 2017; 103:e89. [PMID: 28007286 DOI: 10.1016/j.athoracsur.2016.07.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 07/10/2016] [Accepted: 07/15/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - Thomas K Jones
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - William L Lombardi
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - Mark Reisman
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington
| | - Jay D Pal
- Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Washington.
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31
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Mechanical and pharmacologic treatment in a patient with a coronary artery aneurysm and acute coronary syndrome. Coron Artery Dis 2017; 28:358-360. [PMID: 28225388 DOI: 10.1097/mca.0000000000000475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Fry J, Naqvi A, Bahia A, Seto A. Aspiration thrombectomy and intracoronary tirofiban via GuideLiner ® catheter for a thrombosed aneurysmal vessel. Future Cardiol 2017; 13:131-135. [PMID: 28169555 DOI: 10.2217/fca-2016-0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 52-year-old Asian male with no traditional risk factors for coronary artery disease presented with acute coronary syndrome. Coronary angiography showed complete thrombotic occlusion of the left circumflex with a large thrombus burden in the setting of diffuse aneurysmal enlargement of the coronary arteries consistent with antecedent Kawasaki disease. Manual thrombectomy with adjunctive intracoronary tirofiban was performed utilizing the GuideLiner catheter® (Vascular Solutions, Inc., MN, USA). Stent implantation was deferred. Follow-up imaging 48 h later showed preserved coronary flow and decreased thrombus burden. The GuideLiner catheter, a monorail guiding device, served a novel role in thrombus aspiration and intracoronary medication delivery.
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Affiliation(s)
- James Fry
- Department of Medicine, University of California, Irvine, 101 The City Drive, Suite #400, Orange, CA 92868, USA
| | - Ali Naqvi
- Department of Medicine, University of California, Irvine, 101 The City Drive, Suite #400, Orange, CA 92868, USA
| | - Amit Bahia
- Department of Medicine, University of California, Irvine, 101 The City Drive, Suite #400, Orange, CA 92868, USA
| | - Arnold Seto
- Department of Medicine, University of California, Irvine, 101 The City Drive, Suite #400, Orange, CA 92868, USA
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33
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Sciacca S, Raffa GM, Gentile G, Pilato M. From Small Coronary Artery Aneurysm to Giant Left Ventricle Aneurysm. Med Princ Pract 2017; 26:87-89. [PMID: 27603926 PMCID: PMC5588307 DOI: 10.1159/000450646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/07/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To underscore how challenging the treatment of a coronary artery aneurysm (CAA) can be and highlight the need for consensus guidelines based on focused registries. CLINICAL PRESENTATION AND INTERVENTION A 58-year-old man presented with acute coronary syndrome and underwent elective stent placement on a right CAA. The procedure was complicated by inferior acute myocardial infarction; 8 months later, due to remodeling toward a left ventricular aneurysm of the inferior wall, he experienced several episodes of sustained ventricular tachycardia that required urgent surgical treatment. CONCLUSION The best therapeutic option for CAA is still a matter of controversy, and though the percutaneous approach can meet the technical challenges, 'heart team'-based decision-making is recommended. The case reported here showed that percutaneous treatment of CAA can be a challenging procedure, even in experienced and high-volume centers. In our patient's case, undersizing the covered stent led to further migration and to a complication that was more severe than the original disease.
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Affiliation(s)
- Sergio Sciacca
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Palermo, Italy
| | - Giuseppe Maria Raffa
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Palermo, Italy
- *Giuseppe Raffa, MD, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione, Via Tricomi 5, IT–90127 Palermo (Italy), E-Mail
| | - Giovanni Gentile
- Radiology Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Michele Pilato
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Palermo, Italy
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34
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Devabhaktuni S, Mercedes A, Diep J, Ahsan C. Coronary Artery Ectasia-A Review of Current Literature. Curr Cardiol Rev 2016; 12:318-323. [PMID: 27142049 PMCID: PMC5304254 DOI: 10.2174/1573403x12666160504100159] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/28/2016] [Accepted: 03/04/2016] [Indexed: 12/29/2022] Open
Abstract
Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders. Its incidence ranges from 1.2%-4.9%. Coronary artery ectasia likely represents an exaggerated form of expansive vascular remodeling (i.e. excessive expansive remodeling) in response to atherosclerotic plaque growth with atherosclerosis being the most common cause. Although, it has been described more than five decades ago, its management is still debated. We therefore reviewed the literature until date by searching PubMed and Google scholar using key words “coronary artery ectasia”, “coronary artery aneurysm”, “pathophysiology”, “diagnosis”, “management” either by itself or in combination. We reviewed the full articles and review articles and focused mainly on pathophysiology, diagnosis and management of CAE.
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35
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Chiu P, Lynch D, Jahanayar J, Rogers IS, Tremmel J, Boyd J. Bilateral Giant Coronary Artery Aneurysms Complicated by Acute Coronary Syndrome and Cardiogenic Shock. Ann Thorac Surg 2016; 101:e95-7. [DOI: 10.1016/j.athoracsur.2015.06.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/04/2015] [Accepted: 06/22/2015] [Indexed: 02/08/2023]
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36
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Dahhan A. Coronary artery ectasia in atherosclerotic coronary artery disease, inflammatory disorders, and sickle cell disease. Cardiovasc Ther 2015; 33:79-88. [PMID: 25677643 DOI: 10.1111/1755-5922.12106] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Coronary artery ectasia (CAE) or aneurysm is usually defined as dilation ≥1.5-fold the normal vessel diameter. It has an incidence of 1.4-5.3% and is associated with a wide variety of etiologies-mainly congenital, atherosclerotic, and inflammatory ones. CAE is very common in sickle cell disease, and possibly sickle cell trait, with an incidence of 17.7%. It is likely related to the inflammatory process associated with hemoglobin S. Prognosis depends mainly on the underlying etiology. Atherosclerotic CAE does not carry additional risks compared to atherosclerotic coronary artery disease (ACAD) without ectasia. However, isolated CAE in the absence of ACAD carries an increased risk of myocardial infarction (MI) due to vasospasm, slower coronary blood flow, and thrombosis, typically within the dilated segments. Due to lack of studies and guidelines, management recommendations are based on personal experiences. Therapy should be tailored to each individual case after assessment of severity, history of complications, underlying etiology, and comorbidities. Treatment of underlying condition and avoidance of exacerbating factors are essential. Medical therapy in general may include antiplatelets, β-blockers, angiotensin-converting enzyme inhibitors statins, and dihydropyridine calcium channel blockers. In severe CAE or history of MI, the addition of anticoagulation therapy after assessing bleeding risk may be warranted. In acute MI, the large thrombus burden in the dilated segment makes the percutaneous approach very challenging. Aspiration attempts can result in distal thromboembolization. Survival is better in bypass grafting than with medical therapy. Nonetheless, bypass grafting does not improve survival in atherosclerotic CAE. Depending on the physical characteristics of aneurysm, different surgical approaches can be sought; however, the ideal one is unclear.
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Affiliation(s)
- Ali Dahhan
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
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Cuttone F, Guilbeau-Frugier C, Roncalli J, Glock Y. Left circumflex artery aneurysm: the end-to-end reconstruction. Interact Cardiovasc Thorac Surg 2015; 21:243-5. [PMID: 25991573 DOI: 10.1093/icvts/ivv130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/24/2015] [Indexed: 11/15/2022] Open
Abstract
This report describes a surgical myocardial revascularization procedure for a huge, atherosclerotic left circumflex coronary artery aneurysm. The technique proposed in this paper is based on the isolation of the aneurysm followed by the aneurysmectomy and a complete reconstruction of the circumflex artery by an end-to-end anastomosis.
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Affiliation(s)
- Fabio Cuttone
- Department of Cardiac Surgery, University Hospital (CHU), Toulouse, France
| | | | - Jérome Roncalli
- Department of Cardiology, University Hospital (CHU), Toulouse, France
| | - Yves Glock
- Department of Cardiac Surgery, University Hospital (CHU), Toulouse, France
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Pontailler M, Vilarem D, Paul JF, Deleuze PH. Isolated huge aneurysm of the left main coronary artery in a 22-year-old patient with type 1 neurofibromatosis. Ann Thorac Surg 2015; 99:1055-8. [PMID: 25742828 DOI: 10.1016/j.athoracsur.2014.05.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 04/13/2014] [Accepted: 05/07/2014] [Indexed: 11/25/2022]
Abstract
A 22-year-old patient with neurofibromatosis type 1 presented with acute chest pain. A computed tomography scan and coronary angiography revealed a partially thrombosed huge aneurysm of the left main coronary artery. Despite medical treatment, the patient's angina recurred. The patient underwent a coronary bypass grafting operation and surgical exclusion of the aneurysm. Postoperative imaging disclosed good permeability of the 3 coronary artery bypass grafts and complete thrombosis of the excluded aneurysm.
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Affiliation(s)
- Margaux Pontailler
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Didier Vilarem
- Department of Cardiology, Valenciennes General Hospital, Valenciennes, France
| | - Jean-François Paul
- Department of Radiology, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Philippe H Deleuze
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France.
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Jahangeer S, Anjum N, O'Donnell A, Doddakula K. Surgical repair of an asymptomatic giant right coronary artery aneurysm. Thorac Cardiovasc Surg Rep 2014; 2:6-8. [PMID: 25360401 PMCID: PMC4176070 DOI: 10.1055/s-0033-1348947] [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: 02/10/2013] [Accepted: 05/15/2013] [Indexed: 11/17/2022] Open
Abstract
Background Coronary artery aneurysm (CAA) is a rare finding, being mostly diagnosed on angiography or at autopsies. It is defined as being a dilation of the coronary artery that exceeds the diameter of the patient's largest coronary vessel by 1.5 to 2 times. Case Report We describe the operative correction of a giant right CAA measuring in excess of 10 cm. Conclusion Management of giant CAAs is not standardized and surgical strategy remains controversial. In our case, the patient has a successful surgical repair with no postoperative shunts on follow-up investigations.
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Affiliation(s)
- Saleem Jahangeer
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - Nadeem Anjum
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - Aonghus O'Donnell
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - Kishore Doddakula
- Department of Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
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Jahollari A, Sarac A, Tafaj O, Ozal E. Surgical management of a giant right coronary artery aneurysm. Heart Surg Forum 2014; 17:236-7. [PMID: 25179967 DOI: 10.1532/hsf98.2014349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<p>Coronary artery aneurysm (CAA) is a rare entity, defined as localized dilation that exceeds the normal vessel diameter by a factor of 1.5. A giant CAA is described as a very large dilation, when diameter exceeds 20 mm. CAA has a preva-lence of 0.02% [Markis 1976]. Different factors may lead to CAA formation, including Kawasaki disease, atherosclerosis, congenital malformations, autoimmune and infectious disor-ders, and percutaneous interventions [Hartnell 1985]. Man-agement of these patients remains controversial due to a lack of data from large series studies.</p><p>We reported a case of a young female patient, who pre-sented with an acute inferior infarction and was diagnosed with a giant right coronary artery (RCA) aneurysm. She underwent aneurysmectomy and revascularization on a beat-ing heart through a right lateral thoracotomy. Due to the minimally invasive nature of this procedure, the patient was able to recover quickly without substantial cosmetic changes.</p>
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Affiliation(s)
- Artan Jahollari
- Department of Cardiovascular Surgery, Medical Park Hospital, Samsun, Turkey
| | - Atilla Sarac
- Department of Cardiovascular Surgery, Medical Park Hospital, Samsun, Turkey
| | - Olta Tafaj
- Endocrine Research Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ertugrul Ozal
- Department of Cardiovascular Surgery, Medical Park Hospital, Samsun, Turkey
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Nomura F, Ohno T. In situ coronary-coronary bypass grafting for a huge left coronary aneurysm. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:622-4. [PMID: 23995349 DOI: 10.5761/atcs.cr.13-00101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surgical treatment for an atherosclerotic huge coronary aneurysm is very rare. We have reported 58 years old male who had a huge growing aneurysm in left circumflex coronary artery and underwent aneurysmectomy and coronary-coronary bypass grafting with saphenous vein.
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Affiliation(s)
- Fumikazu Nomura
- Cardiovascular Center Hokkaido Ohno Hospital, Sapporo, Hokkaido, Japan
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Singh SK, Goyal T, Sethi R, Chandra S, Devenraj V, Rajput NK, Kaushal D, Tewarson V, Gupta S, Kumar S. Surgical treatment for coronary artery aneurysm: a single-centre experience. Interact Cardiovasc Thorac Surg 2013; 17:632-6. [PMID: 23803224 DOI: 10.1093/icvts/ivt282] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Coronary artery aneurysm is a rare condition with a reported incidence of 0.14-4.9% in patients undergoing coronary angiography and 0.3-5.3% in patients after percutaneous transluminal coronary angioplasty (PTCA). Optimum surgical therapy for this entity is difficult to standardize. We present here a series of 4 cases with the aim of establishing an optimal surgical therapy for this rare entity. METHODS Four cases of coronary artery aneurysm were admitted in the Department of Cardiology and Department of Cardiothoracic and Vascular Surgery, King George's Medical University, Lucknow, from April 2010 to April 2012. All patients underwent a surgical procedure that involved ligation and plication of the aneurysm with coronary artery bypass grafting. RESULTS Out of the four coronary artery aneurysm patients, 1 was atherosclerotic and the remaining 3 patients developed coronary artery aneurysm after PTCA with a drug eluting stent to the left anterior descending artery. After surgery, all patients recovered uneventfully without any recurrence of symptoms in the follow-up. CONCLUSIONS Coronary artery aneurysm is a rare entity and is being seen more frequently with the increasing use of stents during PTCA. Proximal ligation and plication of the aneurysm with coronary artery bypass grafting in the present series provided good results. With this case series, we seek to establish an optimal surgical therapy for this rare entity.
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Affiliation(s)
- Sushil Kumar Singh
- Department of Cardiothoracic and Vascular Surgery, King George's Medical University, Lucknow, India
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Tuncer E, Onsel Turk U, Alioglu E. Giant saccular aneurysm of the left main coronary artery. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2013; 10:110-2. [PMID: 23610581 PMCID: PMC3627708 DOI: 10.3969/j.issn.1671-5411.2013.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 12/22/2012] [Accepted: 01/30/2013] [Indexed: 11/18/2022]
Abstract
Coronary aneurysms represent anomalies identified in 0.15%-4.9% of patients undergoing coronary angiography. At present, there is no uniform definition of this pathology. Aneurysms of the left main coronary artery (LMCA) are extremely uncommon, with an incidence of 0.1%. It has been demonstrated that atherosclerosis is the main cause of these anomalies in adults, and Kawasaki disease in children and adolescents. Other causes include connective tissue disorders, trauma, vasculitis, congenital, mycotic, and idiopathic. These dilated sections of the coronary artery are not benign pathology because they are subject to spasm, thrombosis, and subsequent distal embolism, spontaneous dissection and rupture. Treatment options include anticoagulation, custom-made covered stents, reconstruction, resection, and exclusion with bypass. Our report on an old case illustrates the giant saccular LMCA aneurysm leading to myocardial ischemia due to coronary steal phenomenon.
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Affiliation(s)
- Esref Tuncer
- Department of Cardiology, Central Hospital, 2/2 Bayrakli, Izmir 35050, Turkey
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Natural history, clinical consequences, and morphologic features of coronary arterial aneurysms in adults. Am J Cardiol 2011; 108:814-21. [PMID: 21791334 DOI: 10.1016/j.amjcard.2011.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 05/01/2011] [Accepted: 05/01/2011] [Indexed: 11/20/2022]
Abstract
Clinical and morphologic features are described in 20 adults (15 men) aged 17 to 85 years (mean 56) who at necropsy were found to have ≥1 aneurysm in ≥1 of their 3 major (right, left anterior descending, and left circumflex) epicardial coronary arteries. Of the 34 coronary aneurysms in the 20 patients (single in 10 patients, ≥2 in 10 patients), 27 (79%) contained intra-aneurysmal thrombi, and in each, the thrombus severely narrowed the lumen. Additionally, atherosclerotic plaque was present in the aneurysmal wall in all 27 aneurysms containing thrombi and also in the major coronary arteries uninvolved by aneurysm. The causes of the aneurysms in the 16 patients with intra-aneurysmal thrombi were therefore considered atherosclerotic. In the other 4 patients, with 7 aneurysms, none contained intra-aneurysmal thrombus or atherosclerotic plaque, and the aneurysms were considered congenital. Clinical diagnosis of coronary aneurysm was not made in any of the 20 patients, but none had proper imaging studies during life. Despite the coronary aneurysms and the associated luminal narrowing, only 8 patients (40%) had left ventricular wall scarring or necrosis or clinical evidence of myocardial ischemia. Proper therapy remains ill defined.
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Bittencourt MS, de Oliveira ALV, Gowdak LHW, César LAM. Left main coronary artery aneurysm associated with anterior wall myocardial infarction. J Cardiol Cases 2011; 4:e5-e7. [DOI: 10.1016/j.jccase.2011.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/09/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022] Open
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Atherosclerotic left main coronary artery aneurysm—Case reports. Int J Angiol 2011. [DOI: 10.1007/s00547-004-1066-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Danzi GB, Pomidossi GA, Casolo F, Centola M, Ferraresi R, Lotan C. A new device to seal large coronary aneurysms: a case report. J Med Case Rep 2010; 4:238. [PMID: 20682025 PMCID: PMC2920272 DOI: 10.1186/1752-1947-4-238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 08/03/2010] [Indexed: 11/16/2022] Open
Abstract
Introduction Coronary artery aneurysm is an uncommon disease. It is defined as a coronary artery dilatation, exceeding the diameter of the normal adjacent segment or the diameter of the patient's largest coronary vessel by 1.5 to 2 times. Coronary artery aneurysms are typically diagnosed by coronary angiography. The prognosis of coronary artery aneurysm is not well known and the management is challenging. Case presentation A 68-year-old Italian-Caucasian man presented to our hospital with angina. Coronary angiography revealed a large coronary aneurysm of the right coronary artery, which was successfully treated by the percutaneous implantation of an MGuard™stent. Conclusion This case report provides evidence that coronary artery aneurysms, even if very large, can be safely treated by MGuard™stent implantation. We strongly emphasize the high flexibility and good deliverability of this device, which leads to the complete exclusion of the aneurysm mediated by the process of endothelization of its thin mesh sleeves.
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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: 106] [Impact Index Per Article: 7.6] [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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Abstract
Coronary artery aneurysms or ectasias are dilatations of arterial segments, which are typically incidentally identified at angiography. Several large clinical series have described the epidemiology and natural history of these malformations. The most common etiologic factor for coronary aneurysms is atherosclerotic coronary artery disease, but they can also be congenital or secondary to inflammatory or connective tissue disorders, with a well-known association with Kawasaki disease. Treatment may consist of surgical, percutaneous, or medical interventions. This review summarizes the current state of knowledge on coronary artery aneurysms and highlights important unresolved questions.
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Abstract
Left main (LM) coronary artery aneurysm is rare and usually found incidentally during coronary angiography. Except for rare Kawasaki disease, iatrogenic and mycotic aneurysms, atherosclerosis is the primary cause of coronary aneurysm. In most clinical scenarios, coronary artery disease is accompanied with LM coronary aneurysm. Although coronary artery aneurysm does not confer added risk in patients with coexisting obstructive coronary artery disease, LM coronary aneurysm itself remains a significant clinical concern. Thrombosis and distal embolization are the most likely reasons to cause morbidities. Aggressive surgical treatment should be considered. Here, we report a 65-year-old man presenting with effort angina. LM coronary aneurysm was noted in coronary angiogram and images including computed tomography, transesophageal echocardiography and operative photography were presented.
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Affiliation(s)
- Tzu-Yu Lin
- Department of Anesthesia, Far-Eastern Memorial Hospital, Taipei, Taiwan
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