1
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Sohail AA, Wahab R, Rehman HU, Fatimi A, Fatimi SH. A rare case of diffuse ectasia in the coronary arteries and proximal aneurysm in the left anterior descending artery: A case report. Int J Surg Case Rep 2023; 111:108795. [PMID: 37713962 PMCID: PMC10507129 DOI: 10.1016/j.ijscr.2023.108795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION Coronary artery aneurysm is defined as dilatation of a segment of coronary artery, greater than 1.5 times the diameter of the largest normal coronary artery of the patient. Major cause of coronary artery aneurysm is coronary artery disease. Coronary artery aneurysm maybe an incidental finding during coronary angiography or it may present with symptoms including chest pain, myocardial infarction or even death. CASE PRESENTATION We present a rare case of a 59-year-old gentleman, who had, previously, underwent multiple left heart catheterizations and percutaneous coronary interventions. He presented to us with symptomatic diffuse ectasia of the coronary arteries with proximal aneurysm in the Left Anterior Descending Artery. DISCUSSION Coronary artery aneurysms are very rare with an incidence of about 0.02 %-0.04 % and a prevalence of 0.3 %-12 %. Right Coronary Artery is the principal site coronary artery aneurysms with a predominance of 83.8 %. The occurrence of multiple aneurysms is a very rare finding. About 73 % patients present with single aneurysms while only 27 % present with multiple aneurysms. Coronary artery aneurysms predispose to various complications including compression of the chambers, thrombosis and rupture. CONCLUSION From the presented case it can be concluded that even though, conservative management is available, surgical repair is the gold standard treatment, especially in the presence of multiple, symptomatic and large aneurysms in order to avoid fatal ischemic complications.
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Affiliation(s)
- Abdul Ahad Sohail
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Rida Wahab
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Haseeb Ur Rehman
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Asad Fatimi
- Aga Khan University Hospital, Karachi, Pakistan.
| | - Saulat Hasnain Fatimi
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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2
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Gao H, Li H. Case report: Giant coronary artery aneurysms with severe stenosis and multiple abdominal artery aneurysms. Front Med (Lausanne) 2023; 10:1187690. [PMID: 37305129 PMCID: PMC10248131 DOI: 10.3389/fmed.2023.1187690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
Background Giant coronary artery aneurysms (GCAAs) were relatively rare. Little was known about its characteristics, its etiology and its therapy. GCAAs with multiple abdominal artery aneurysms (AAAs) were more unusual and rarer. Case presentation A 29-year-old female presented to our hospital with abrupt-onset abdominal pain in the left upper quadrant and then she died in 2018. In 2016, prior to this visit, she came to our department for intermittent retrosternal compression pain during rest or sports activities. Medical history showed she had a coronary artery aneurysm (CAA) in 2004. We found evidence of multiple coronary aneurysms with severe stenosis and multiple AAAs and coronary artery bypass grafting (CABG) was carried out. In combination with laboratory analysis, imaging studies, and pathological examination, CAA may result from the long-term effects of Kawasaki disease (KD). Finally, the patient died of a ruptured abdominal aneurysm. Conclusions We report a rare case of GCAAs with severe stenosis and multiple AAAs in a young woman with a history of KD-induced coronary aneurysm. Although the understanding of the optimal treatment strategy for GCAAs combined with multiple aneurysms was limited, we found that CABG was effective in the treatment of GCAAs in this patient. In the clinical treatment of patients with GCAAs, attention should be paid to the examination of systemic blood vessels.
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3
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Tsuda K, Kiyomatsu K, Teramachi Y, Suda K. A case of incomplete Kawasaki disease - A 2-month-old infant with 1 day of fever who developed multiple arterial aneurysms. Ann Pediatr Cardiol 2022; 15:536-538. [PMID: 37152506 PMCID: PMC10158483 DOI: 10.4103/apc.apc_39_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/07/2022] [Accepted: 06/11/2022] [Indexed: 03/02/2023] Open
Abstract
Kawasaki disease (KD) is a systemic vasculitis and is the most frequent pediatric acquired heart disease in developed countries. The diagnosis of KD is typically made by the: ≧ 5 of 6 principal signs. However, approximately 20% of KD patients present with less than 5 of these diagnostic signs but may be suffering from coronary artery aneurysms and have been diagnosed with incomplete KD. In this case report, we describe a 2-month-old infant who showed just fever without any other signs of KD but was suffered from multiple arterial aneurysms, including coronary, pulmonary, and carotid arteries. Because she did not respond to intravenous immunoglobulin infusion, we placed her on plasma exchange that has successfully brought defervescence without any significant complications. This case may represent the end spectrum of incomplete KD in very young infants.
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Affiliation(s)
- Keitaro Tsuda
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Kurume, Kyushu, Japan
| | - Kouki Kiyomatsu
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Kurume, Kyushu, Japan
| | - Yozo Teramachi
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Kurume, Kyushu, Japan
| | - Kenji Suda
- Department of Pediatrics and Child Health, School of Medicine, Kurume University, Kurume, Kyushu, Japan
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4
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Lee JJY, Feldman BM, McCrindle BW, Li P, Yeung RS, Widdifield J. Evaluating the time-varying risk of hypertension, cardiac events, and mortality following Kawasaki disease diagnosis. Pediatr Res 2022; 93:1439-1446. [PMID: 36002584 DOI: 10.1038/s41390-022-02273-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study evaluated the risk of hypertension, major adverse cardiac events (MACE), and all-cause mortality in Kawasaki disease (KD) patients up to young adulthood. METHODS An inception cohort of 1169 KD patients between 1991 and 2008 from a tertiary-level hospital in Ontario, Canada was linked with health administrative data to ascertain outcomes up to 28 years of follow-up. Their risk was compared with 11,690 matched population comparators. The primary outcome was hypertension and secondary outcomes were MACE and death. RESULTS After a median follow-up of 20 years [IQR: 8.3], the cumulative incidence of hypertension and MACE in the KD group was 3.8% (95% CI: 2.5-5.5) and 1.2% (95% CI: 0.6-2.4%), respectively. The overall survival probability in the KD group was 98.6% (95% CI: 97.2-99.3%). Relative to comparators, KD patients were at an increased risk for hypertension [aHR: 2.2 (95% CI: 1.5-3.4)], death [aHR: 2.5 (95% CI: 1.3-5.0)], and MACE [aHR: 10.7 (95% CI: 6.4-17.9)]. For hypertension and MACE, the aHR was the highest following diagnosis and then the excess risk diminished after 16 and 13 years of follow-up, respectively. MACE occurred largely in KD patients with coronary aneurysms [cumulative incidence: 12.8%]. CONCLUSIONS KD patients demonstrated a reassuring cardiac prognosis up to young adulthood with low events and excellent survival. KD patients were at increased risk for hypertension, but this excess risk occurred early and declined with time. IMPACT With the current standard of care, KD patients demonstrated favorable cardiac prognosis, with low events of hypertension, MACE, and excellent survival. Hypertension and MACE risk appear to be highest around the time of KD diagnosis. MACE occurred primarily in KD patients with coronary aneurysms. Our findings are reassuring to KD patients, families, and their providers. Our study demonstrated an association between KD exposure and hypertension. This association is relatively novel. Previous studies have remained conflicting if KD contributes to long-term atherosclerotic risk.
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Affiliation(s)
- Jennifer J Y Lee
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada. .,ICES, Toronto, ON, Canada. .,University of Toronto, Toronto, ON, Canada.
| | - Brian M Feldman
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brian W McCrindle
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - Rae Sm Yeung
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Jessica Widdifield
- ICES, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, & Evaluation, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
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5
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Negro F, Gentile F, Rizza A, Giannoni A, Bianchi G, Clemente A, Emdin M, Palmieri C. Etiology, clinical presentation, and management of left main coronary artery aneurysms. J Card Surg 2022; 37:3675-3686. [PMID: 35989523 DOI: 10.1111/jocs.16870] [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: 05/13/2022] [Revised: 06/11/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY The widespread use of noninvasive/invasive coronary imaging increased the probability of recognition of coronary aneurysms. Left main coronary aneurysms (LMCA), though rare, are potentially life-threatening but in the absence of controlled studies, guidelines do not provide any specific recommendation for their management. We, therefore, aimed to investigate the epidemiology, clinical presentation, therapeutic strategies, and prognostic implication of LMCA. METHODS A systematic review of the literature was performed to retrieve all the reported cases of LMCA as of December 2021, which were summarized and classified according to their etiology, clinical presentation, and therapeutic management. RESULTS Out of 1997 works retrieved, 180 studies were analyzed, describing 209 LMCA cases (aged 51 ± 19 years, 68% males). Atherosclerosis was the most common etiology (40%), followed by inflammatory (12%), congenital (9%), or degenerative (6%) conditions. Stable angina (43%) and acute coronary syndromes (32%) were more often the first clinical manifestations, while 29 (14%) LMCA were incidental findings. Most cases were treated surgically (53%), while percutaneous intervention was rarely adopted (7%). Data about antithrombotic therapies were scarce and heterogeneous. Finally, when longitudinal data were reported (n = 81), LMCA resulted associated with a severe prognosis, with a 15% mortality over an 8-month median follow-up. CONCLUSIONS LMCA are most frequently, but not exclusively, caused by advanced atherosclerosis. Irrespective of their etiology and clinical presentation, LMCA may be associated with high short-term mortality. In absence of controlled studies, a careful evaluation of each case is warranted to optimize therapeutic strategies.
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Affiliation(s)
- Francesco Negro
- Division of Cardiology, Pisa University Hospital, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy
| | - Francesco Gentile
- Division of Cardiology, Pisa University Hospital, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy
| | - Antonio Rizza
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy
| | - Alberto Giannoni
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy.,Health Science Interdisciplinary Research Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giacomo Bianchi
- Division of Adult Cardiac Surgery, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Alberto Clemente
- Division of Radiology, Fondazione Toscana "G. Monasterio", Pisa, Italy
| | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy.,Health Science Interdisciplinary Research Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Cataldo Palmieri
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy
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6
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Tsai CM, Chang HY, Wu IH, Yang LT. A Tragic Case with Multifocal Cerebral, Coronary and Abdominal Aneurysms. ACTA CARDIOLOGICA SINICA 2022; 38:546-548. [PMID: 35873123 PMCID: PMC9295036 DOI: 10.6515/acs.202207_38(4).20220121c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/21/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Chieh-Mei Tsai
- Department of Internal Medicine, College of Medicine, National Taiwan University
| | | | - I-Hui Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Tan Yang
- Department of Internal Medicine, College of Medicine, National Taiwan University;
,
Department of Internal Medicine
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7
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de Paula CDP, Rassi DDC, Masson Silva JB, de Oliveira ACR, Vieira Junior E, de Freitas Junior AF, Rassi S. Multivessel coronary artery aneurysms as a complication of chronic active Epstein-Barr virus infection: an atypical and occasional complication. J Cardiovasc Comput Tomogr 2022; 16:e45-e46. [DOI: 10.1016/j.jcct.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/01/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022]
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8
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Chan S. A rare case of sudden death due to IgG4-related giant coronary artery aneurysms. J Forensic Sci 2021; 67:363-369. [PMID: 34338306 DOI: 10.1111/1556-4029.14824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/08/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a fibro-inflammatory condition that can affect many organs, either simultaneously or metachronously. In recent years, IgG4-related vascular complications of larger arteries such as the aorta and iliac arteries have been increasingly identified. Among vascular complications, coronary artery involvement in the forms of either periarteritis or coronary artery aneurysms (CAAs) has also been reported; however, are very rare in comparison. This case report presents a rare case of a sudden death due to occlusive thrombosis of IgG4-related giant CAAs measuring up to 10 cm in diameter, demonstrates their possible clinical progression, and shows how they can distort normal anatomy which may then pose challenges in the interpretation of postmortem-computed tomography scans. It also briefly discusses the diagnosis of IgG4-RD in arteries, both clinically and in the postmortem setting.
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Affiliation(s)
- Shijia Chan
- Forensic Medicine Division, Health Sciences Authority, Singapore, Singapore
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9
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Yuan H, Wu Z, Wu Q, Lu T, Tang Y, Huang C. Case Report: Isolate Congenital Coronary Artery Fistula With Giant Artery Aneurysm in a Neonate. Front Cardiovasc Med 2021; 8:633840. [PMID: 34222358 PMCID: PMC8241900 DOI: 10.3389/fcvm.2021.633840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
A rare case of neonatal congenital coronary artery, right ventricle fistula with giant coronary artery aneurysm formation, was reported. Computed tomography angiography demonstrated the dilated and tortuous tunnel arising from the right aortic sinus and traversing the epicardial surface before opening into the anterolateral aspect of the RV. Successful surgical repair was performed with a patch closure of the fistula and coronary angioplasty. The postoperative recovery was uneventful. Our experience of this rare congenital heart disease demonstrated that early surgical repair of coronary artery fistula and coronary angioplasty in the neonate can be performed safely. Further study is needed to seek the basis on this.
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Affiliation(s)
- Haoyong Yuan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Qin Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Yilun Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Can Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
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10
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Cardiac Involvement in Autosomal Dominant Polycystic Kidney Disease. CARDIOGENETICS 2021. [DOI: 10.3390/cardiogenetics11020006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disorders are the main complication in autosomal dominant polycystic kidney disease (ADPKD). contributing to both morbidity and mortality. This review considers clinical studies unveiling cardiovascular features in patients with ADPKD. Additionally, it focuses on basic science studies addressing the dysfunction of the polycystin proteins located in the cardiovascular system as a contributing factor to cardiovascular abnormalities. In particular, the effects of polycystin proteins’ deficiency on the cardiomyocyte function have been considered.
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11
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Yadav A, Godasu G, Buxi TBS, Sheth S. Multiple Artery Aneurysms: Unusual Presentation of IgG4 Vasculopathy. J Clin Imaging Sci 2021; 11:17. [PMID: 33880242 PMCID: PMC8053435 DOI: 10.25259/jcis_149_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/01/2021] [Indexed: 01/13/2023] Open
Abstract
Immunoglobulin G4 (IgG4)-related disease is a chronic systemic disease. It is characterized by inflammatory fibrosis and high serum IgG4 levels. IgG4-positive plasma cells infiltrate target organs in this disease. It may involve the pancreas, biliary tract, lacrimal glands, salivary glands, orbits, thyroid, kidneys, lymph nodes, or retroperitoneum. It may present as vasculitis with involvement of large to medium sized vessels such as the aorta, the common iliac, carotid, and coronary arteries. We present a case of 55-year-old male patient who presented with shortness of breath on exertion and atypical chest pain. On CT angiography, a giant coronary artery aneurysm involving the left anterior descending artery, multiple visceral and intercostal artery aneurysms, and nodular paravertebral soft-tissue thickening secondary to IgG4 vasculopathy.
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Affiliation(s)
- Anurag Yadav
- Department of Computed Tomography and Magnetic Resonance Imaging, Sir Ganga Ram Hospita, New Delhi, India
| | - Geetha Godasu
- Department of Radiodiagnosis, Sir Ganga Ram Hospital, New Delhi, India
| | - Tarvinder Bir Singh Buxi
- Department of Computed Tomography and Magnetic Resonance Imaging, Sir Ganga Ram Hospita, New Delhi, India
| | - Swapnil Sheth
- Department of Computed Tomography and Magnetic Resonance Imaging, Sir Ganga Ram Hospita, New Delhi, India
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12
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Hindawy AR, Daboul B, Hanafi I, Albitar S. Association of autosomal dominant polycystic kidney disease, asymptomatic multiple giant coronary arteries aneurysms and abdominal aortic aneurysm: a case report. Oxf Med Case Reports 2020; 2020:omaa122. [PMID: 34136265 PMCID: PMC8202766 DOI: 10.1093/omcr/omaa122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/01/2020] [Accepted: 10/31/2020] [Indexed: 11/14/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a systemic disease characterized
by the formation of multiple cysts in several organs. The formation of aneurysms
accompanying this disease is being increasingly reported in the literature, and mutations
in PKD-1 and PKD-2 are suspected in this etiology. Although the association between ADPKD
and multiple coronary arteries aneurysms (CAA) was reported several times, we are
presenting a case with the combination of ADPKD, multiple giant CAAs, abdominal aortic
aneurysms and a suspected intracranial aneurysm, which has never been reported. The
asymptomatic presentation of these multiple aneurysms might support the recommendations
for further diagnostic investigations in these patients.
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Affiliation(s)
- Abdullah Rida Hindawy
- Division of Nephrology, Department of Internal Medicine, Aleppo University Hospital, Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Baraa Daboul
- Department of Internal Medicine, Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Ibrahem Hanafi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Sami Albitar
- Division of Nephrology, Department of Internal Medicine, Aleppo University Hospital, Faculty of Medicine, University of Aleppo, Aleppo, Syria
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13
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Rare case of a giant thrombosed left anterior descending coronary artery aneurysm. J Cardiothorac Surg 2020; 15:204. [PMID: 32731891 PMCID: PMC7393696 DOI: 10.1186/s13019-020-01250-8] [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: 04/19/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Coronary artery aneurysms (CAAs) are rare, and giant CAAs are even rarer. The pathophysiology of this phenomenon is still unknown. Case presentation Herein, we present the case of a 49-year-old male with a giant aneurysm in the left anterior descending artery. Conclusions The optimal treatment for CAAs is debatable, but surgical intervention is preferred for giant CAAs.
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14
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Zhao QM, Chu C, Wu L, Liang XC, Sun SN, He L, Zhao L, Wang F, Huang GY, Niu C, Liu F. Systemic Artery Aneurysms and Kawasaki Disease. Pediatrics 2019; 144:peds.2019-2254. [PMID: 31732547 DOI: 10.1542/peds.2019-2254] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Coronary artery aneurysms (CAAs) are a well-known complication of Kawasaki disease (KD), but there are no data on incidence or outcomes of systemic artery aneurysms (SAAs) in the current era. METHODS From April 1, 2016, to March 31, 2019, we screened for SAAs in 162 patients with KD at risk for SAAs with magnetic resonance angiography or peripheral angiography and analyzed incidence and early outcomes of SAAs. RESULTS Twenty-three patients had SAAs, demonstrating an incidence of 14.2% (23 of 162) in patients who were screened at 1 month after onset. The proportion of patients with SAAs was estimated to be 2% (23 of 1148) of all patients with KD. The median age at onset of KD with SAAs was 5 months. All patients with SAAs had CAAs, with z scores >8. Of patients with giant CAAs, 38.6% (17 of 44) had SAAs. A total of 129 SAAs occurred in 17 different named arteries. The most common sites for SAAs were the axillary (18.6%), common iliac (12.4%), and brachial (11.6%) arteries. During a median follow-up time of 6 months, 92.9% (79 of 85) of SAAs had some degree of regression, with 80% (68 of 85) of SAAs returning to normal. The overall regression rate was higher for medium to large SAAs than for medium to giant CAAs. CONCLUSIONS Although the incidence of SAAs may not be as dramatically reduced as we expected compared with previous data, SAAs have a high regression rate during short-term follow-up.
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Affiliation(s)
- Qu-Ming Zhao
- Children's Hospital of Fudan University, Shanghai, China; and.,Contributed equally as co-first authors
| | - Chen Chu
- Children's Hospital of Fudan University, Shanghai, China; and.,Contributed equally as co-first authors
| | - Lin Wu
- Children's Hospital of Fudan University, Shanghai, China; and
| | - Xue-Cun Liang
- Children's Hospital of Fudan University, Shanghai, China; and
| | - Shu-Na Sun
- Children's Hospital of Fudan University, Shanghai, China; and
| | - Lan He
- Children's Hospital of Fudan University, Shanghai, China; and
| | - Lu Zhao
- Children's Hospital of Fudan University, Shanghai, China; and
| | - Feng Wang
- Children's Hospital of Fudan University, Shanghai, China; and
| | - Guo-Ying Huang
- Children's Hospital of Fudan University, Shanghai, China; and
| | - Conway Niu
- Royal Hospital for Children, Glasgow, Scotland
| | - Fang Liu
- Children's Hospital of Fudan University, Shanghai, China; and
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15
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Jindal AK, Pilania RK, Prithvi A, Guleria S, Singh S. Kawasaki disease: characteristics, diagnosis, and unusual presentations. Expert Rev Clin Immunol 2019; 15:1089-1104. [PMID: 31456443 DOI: 10.1080/1744666x.2019.1659726] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Kawasaki disease (KD) is one of the commonest pediatric vasculitides and is associated with a significant risk of development of coronary artery abnormalities if left untreated. Areas covered: In this review, we have highlighted the incomplete and unusual presentations of KD and also emphasize the controversies pertaining to 2D echocardiography in KD. A PubMed search was performed regarding diagnosis and unusual presentations of KD. Expert opinion: Diagnosis of KD is essentially clinical and based on recognition of typical clinical features that may appear sequentially and all signs and symptoms may not be present at one point of time. There is no confirmatory laboratory test for diagnosis of this condition. Further complicating the picture is the fact that incomplete and atypical forms KD may be seen in up to 50% patients. Although 2D echocardiography continues to be the preferred imaging modality for cardiac assessment in patients with KD, it has its limitations.
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Affiliation(s)
- Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Rakesh Kumar Pilania
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Ashwini Prithvi
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Sandesh Guleria
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research , Chandigarh , India
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