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Iliyas M, Abhilash S, Bijulal S. Acute-onset palpitation and presyncope in a young male. Heart 2024; 110:907-926. [PMID: 38885970 DOI: 10.1136/heartjnl-2024-324070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Affiliation(s)
- Mohamed Iliyas
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sreevilasam Abhilash
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sasidharan Bijulal
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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2
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Scarpa J, Zhu A, Morikawa NK, Chan JM. Perioperative Management of Giant Coronary Artery Aneurysm. J Cardiothorac Vasc Anesth 2023; 37:2040-2045. [PMID: 37296024 DOI: 10.1053/j.jvca.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/04/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Julia Scarpa
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY
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3
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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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4
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Degtyar A, Baker TC, Punja M. No Ordinary Coronary: A Case Series of Two Large Coronary Artery Aneuryms Found on Chest X-Ray. J Emerg Med 2023; 64:47-50. [PMID: 36283902 DOI: 10.1016/j.jemermed.2022.09.020] [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: 04/30/2022] [Revised: 07/15/2022] [Accepted: 09/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Post-procedural coronary aneurysms can have high morbidity and mortality. Although found more commonly on ultrasound or computed tomography imaging, if large enough, they may appear on chest x-ray studies. CASE REPORTS We present two cases of coronary artery aneurysm visible on chest x-ray study-one originating from a saphenous vein graft and the other a left anterior descending artery pseudoaneurysm 1 week post heart catheterization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is important for emergency physicians to recognize abnormal chest x-ray studies and to look for post-procedural complications, such as coronary artery aneurysm. Coronary artery aneurysm can be a potentially life-threatening condition requiring prompt recognition and surgical consultation.
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Affiliation(s)
- Aleksandra Degtyar
- Emergency Department, Wellstar Kennestone Regional Medical Center, Marietta, GA
| | - Thomas Cole Baker
- Emergency Department, Wellstar Kennestone Regional Medical Center, Marietta, GA
| | - Mohan Punja
- Emergency Department, Wellstar Kennestone Regional Medical Center, Marietta, GA
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5
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Latif A, Tran A, Ahsan J, Lateef N, Abusina W, Kapoor V, Ahsan Z, Ahmad S, Mirza M. Coronary Artery Aneurysms as a Cause of Acute Coronary Syndrome Presentation - A Focused Review. Curr Cardiol Rev 2023; 19:68-72. [PMID: 36999696 PMCID: PMC10518882 DOI: 10.2174/1573403x19666230331103508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 04/01/2023] Open
Abstract
Coronary artery aneurysms (CAA) are defined as a dilation of a coronary vessel greater than 1.5 times the diameter of a local reference vessel. While CAAs tend to be incidental findings on imaging, they result in complications, such as thrombosis, embolization, ischemia, arrhythmias, and heart failure. Among symptomatic cases, chest pain has been the most common manifestation of CAAs. This necessitates an understanding of CAAs as a cause of acute coronary syndrome (ACS) presentation. However, due to the unclear pathophysiology of CAAs and their variable presentation complicated by similar ACS conditions, there is no clear strategy for CAA management. In this article, we will discuss the contribution of CAAs to ACS presentations and review the current management options for CAAs.
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Affiliation(s)
- Azka Latif
- Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Amy Tran
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Junaid Ahsan
- Division of Cardiovascular Medicine, Mercy Medical Center, Iowa Heart Center, Des Moines, Iowa, USA
| | - Noman Lateef
- Division of Cardiovascular Medicine, University of Nebraska Medicine, Omaha, Nebraska, USA
| | - Waiel Abusina
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Vikas Kapoor
- Department of Medicine, CHI Health Good Samaritan Hospital, Kearney, Nebraska, USA
| | - Zoraiz Ahsan
- Department of Medicine, Pakistan Medical Center, Islamabad, Pakistan
| | - Soban Ahmad
- Department of Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina, USA
| | - Mohsin Mirza
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
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6
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Cano-Castellote M, Afanador-Restrepo DF, González-Santamaría J, Rodríguez-López C, Castellote-Caballero Y, Hita-Contreras F, Carcelén-Fraile MDC, Aibar-Almazán A. Pathophysiology, Diagnosis and Treatment of Spontaneous Coronary Artery Dissection in Peripartum Women. J Clin Med 2022; 11:jcm11226657. [PMID: 36431134 PMCID: PMC9692787 DOI: 10.3390/jcm11226657] [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: 09/20/2022] [Revised: 10/25/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is an infrequent cause of nonobstructive ischemic heart disease in previously healthy young women and therefore is not usually considered in differential diagnoses. The overall incidence of SCAD in angiographic series is between 0.28 and 1.1%, with a clear predominance in young, healthy women (70%) of whom approximately 30% are in the postpartum period. In the United Kingdom, between 2008 and 2012, SCAD was the cause of 27% of acute myocardial infarctions during pregnancy, with a prevalence of 1.81 per 100,000 pregnancies. Regarding the mechanism of arterial obstruction, this may be due to the appearance of an intramural hematoma or to a tear in the intima of the arteries, both spontaneously. Although multiple diagnostic methods are available, it is suggested to include an appropriate anamnesis, an electrocardiogram in the first 10 min after admission to the service or the onset of symptoms, and subsequently, a CT angiography of the coronary arteries or urgent coronary angiography if the hemodynamic status of the patient allows it. Treatment should be individualized for each case; however, the appropriate approach is generally based on two fundamental pillars: conservative medical treatment with antiplatelet agents, beta-blockers, and nitrates, and invasive treatment with percutaneous coronary intervention for stent implantation or balloon angioplasty, if necessary.
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Affiliation(s)
- Marta Cano-Castellote
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | - Diego Fernando Afanador-Restrepo
- Faculty of Distance and Virtual Education, Antonio José Camacho University Institution, Santiago de Cali 760016, Colombia
- ZIPATEFI Research Group, Faculty of Health Sciences and Sports, University Foundation of the Área Andina, Pereira 660001, Colombia
| | - Jhonatan González-Santamaría
- ZIPATEFI Research Group, Faculty of Health Sciences and Sports, University Foundation of the Área Andina, Pereira 660001, Colombia
- Faculty of Health Sciences, Technological University of Pereira, Pereira 660001, Colombia
- Nutrition Sciences Postgraduate, Faculty of Nutrition Sciences, University of Sinaloa, Culiacan 80019, Mexico
| | | | | | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain
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7
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Sharma R, Ruia AV. A case report of pseudoaneurysm of coronary artery within a month of percutaneous coronary intervention. Eur Heart J Case Rep 2022; 6:ytac175. [PMID: 35528126 PMCID: PMC9071343 DOI: 10.1093/ehjcr/ytac175] [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: 08/23/2021] [Revised: 10/27/2021] [Accepted: 04/19/2022] [Indexed: 11/13/2022]
Abstract
Background Coronary artery pseudoaneurysms (PSAs) are uncommon and have poorly understood natural history. Unlike true aneurysms, PSAs do not have all the three layers of the vessel in the aneurysmal wall. The PSAs are most commonly seen after an overzealous percutaneous coronary intervention (PCI) which causes damage to the vessel wall. They usually develop slowly after PCI and PSAs within a month of a PCI are not so common. The PSA may be asymptomatic or present with recurrent angina. Case summary Here, we report a case of symptomatic PSA to right coronary artery (RCA). The patient had a myocardial infarction for which a PCI was performed to deploy a drug-eluting stent (DES) in the RCA. The patient had in-stent restenosis (ISR) within a week of PCI for which plain old balloon angioplasty (POBA) was performed. The patient continued to have unstable angina and within a month of POBA was diagnosed as a case of PSA by intravascular ultrasound. A covered stent was deployed which effectively sealed off the PSA and resumed normal blood flow to distal vessel. Patient has been doing well on medication [aspirin 75 mg once daily, atorvastatin 80 mg once daily, and P2Y12 platelet inhibitor (Ticagrelor) 90 mg twice daily]. Discussion The PSAs usually take 6-9 months to develop. However, PSAs have been reported within 1-2 months of PCI. This case also shows that PSAs can occur within a month of PCI. It is possible that over-aggressive and/or high-pressure dilatation and/or deep engagement during POBA performed to open up the ISR could have damaged the struts of the DES and compressed it against the vascular wall. The resultant vascular wall injury could have been the cause of early PSA formation in this case. Hence, cardiologists should be vigilant enough to suspect PSA, especially in a patient presenting with angina. The case also shows that covered stents are a viable option to treat early presentations of PSA.
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Affiliation(s)
- Raghav Sharma
- Department of Cardiology, Meditrina Hospital, Ambala 133001, Haryana, India
| | - Aditya Vikram Ruia
- Department of Cardiology, Meditrina Hospital, Ambala 133001, Haryana, India
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8
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Ruggerini S, Pavasini R, Quagliara TAP, Fiorani V. Case report: asymptomatic pseudoaneurysm of the native coronary soon after the graft anastomosis treated with off-pump repair. Eur Heart J Case Rep 2022; 6:ytac014. [PMID: 35295729 PMCID: PMC8922691 DOI: 10.1093/ehjcr/ytac014] [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: 08/13/2021] [Revised: 09/15/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022]
Abstract
Background Pseudoaneurysms (PSAs) of native coronary arteries are rare but potentially lethal complications occurring after coronary artery graft anastomosis mainly secondary to median sternotomy. Case summary A 61-year-old man underwent coronary artery bypass grafting because of stable angina. After the surgery, the patient was asymptomatic. A routine pre-discharge transthoracic echocardiogram was performed showing a haematoma of the apex partially involving the right ventricle with systolic colour Doppler flow going from the left ventricle to the pericardium. A coronary computed tomography scan was ordered and it revealed the presence of a PSA of the left anterior descending (LAD) artery distal to the graft anastomosis with the left internal mammary artery. An off-pump direct suture of the LAD injury through a redo sternotomy was successfully performed. Discussion The development of a PSA of a native coronary artery after bypass grafting is a very rare and potentially fatal condition. A correct and prompt diagnosis is crucial to avoid lethal complication.
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Affiliation(s)
- Sara Ruggerini
- Cardiac Surgery Unit, Salus Hospital, Via Ulderico Levi 7, 42121 Reggio Emilia, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Teresa A P Quagliara
- Cardiac Surgery Unit, Salus Hospital, Via Ulderico Levi 7, 42121 Reggio Emilia, Italy
| | - Vinicio Fiorani
- Cardiac Surgery Unit, Salus Hospital, Via Ulderico Levi 7, 42121 Reggio Emilia, Italy
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9
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Matta AG, Yaacoub N, Nader V, Moussallem N, Carrie D, Roncalli J. Coronary artery aneurysm: A review. World J Cardiol 2021; 13:446-455. [PMID: 34621489 PMCID: PMC8462041 DOI: 10.4330/wjc.v13.i9.446] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/09/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
Coronary artery aneurysm (CAA) is a clinical entity defined by a focal enlargement of the coronary artery exceeding the 1.5-fold diameter of the adjacent normal segment. Atherosclerosis is the main cause in adults and Kawasaki disease in children. CAA is a silent progressive disorder incidentally detected by coronary angiography, but it may end with fatal complications such as rupture, compression of adjacent cardiopulmonary structures, thrombus formation and distal embolization. The pathophysiological mechanisms are not well understood. Atherosclerosis, proteolytic imbalance and inflammatory reaction are involved in aneurysmal formation. Data from previously published studies are scarce and controversial, thereby the management of CAA is individualized depending on clinical presentation, CAA characteristics, patient profile and physician experience. Multiple therapeutic approaches including medical treatment, covered stent angioplasty, coil insertion and surgery were described. Herein, we provide an up-to-date systematic review on the pathophysiology, complications and management of CAA.
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Affiliation(s)
- Anthony Georges Matta
- Department of Cardiology, Toulouse University Hospital, Rangueil, Toulouse 31400, France
- Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh 961, Lebanon
| | - Nabil Yaacoub
- Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh 961, Lebanon
| | - Vanessa Nader
- Department of Cardiology, Toulouse University Hospital, Rangueil, Toulouse 31400, France
- Faculty of Pharmacy, Lebanese University, Hadath 961, Lebanon
| | - Nicolas Moussallem
- Division of Cardiology, Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh 961, Lebanon
| | - Didier Carrie
- Department of Cardiology, University Hospital Rangueil, Toulouse 31059, France
| | - Jerome Roncalli
- Department of Cardiology, University Hospital of Toulouse/Institute Cardiomet, Toulouse 31400, France
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10
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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: 24] [Impact Index Per Article: 8.0] [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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11
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Kassab K, Iskander M, Malhotra S, Pyslar N. Delineating anatomy and function with multimodality imaging: a case report of giant right coronary artery aneurysms. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32617482 PMCID: PMC7319827 DOI: 10.1093/ehjcr/ytaa089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/09/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Abstract
Background Giant coronary artery aneurysms (CAAs) are rare and have been reported in patients with connective tissue diseases, arteritides, and atherosclerosis. Given the rarity of the condition, multimodality imaging is essential for comprehensive evaluation of coronary aneurysms and determination of their haemodynamic significance. Case summary A 58-year-old Filipino female was evaluated for dyspnoea on exertion of one month. Chest computed tomography (CT) showed right coronary artery (RCA) aneurysms. Invasive coronary angiogram (ICA) confirmed two giant aneurysms of the RCA. Distal RCA could not be opacified due to contrast stagnation in the proximal aneurysms. Coronary CT angiography (CCTA) depicted an additional giant distal RCA aneurysm not visualized on ICA with intraluminal thrombosis. Contrast-enhanced cardiac magnetic resonance imaging (CMR) revealed delayed time to peak perfusion in the mid to apical inferior walls, on first-pass imaging, without myocardial scarring. Late gadolinium images revealed aneurysmal wall inflammation. Discussion This case highlights the anatomical findings of giant CAA and the application of multimodality imaging for their accurate characterization. While ICA confirmed the presence of the aneurysms, CCTA enabled the assessment of their full extent and depict intraluminal thrombosis. Contrast-enhanced CMR delineated aneurysm wall characteristics, with first-pass images demonstrating reduced inferior wall perfusion at rest, which was likely the cause of patient’s exertional symptoms. Management of giant coronary aneurysms involves surgical resection with bypass grafting.
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Affiliation(s)
- Kameel Kassab
- Division of Cardiology, Department of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, Room 3620, Chicago, IL 60612, USA
| | - Mina Iskander
- Division of Cardiology, Department of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, Room 3620, Chicago, IL 60612, USA
| | - Saurabh Malhotra
- Division of Cardiology, Department of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, Room 3620, Chicago, IL 60612, USA
| | - Nataliya Pyslar
- Division of Cardiology, Department of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, Room 3620, Chicago, IL 60612, USA
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12
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Namazi MH, Khani M, Faghihi Langroudi T, Abedi F, Tabary M, Khaheshi I. Coronary pseudoaneurysm 1 week after complex percutaneous coronary intervention with drug-eluting stent. Clin Case Rep 2020; 8:1296-1298. [PMID: 32695378 PMCID: PMC7364079 DOI: 10.1002/ccr3.2910] [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: 11/21/2019] [Revised: 02/09/2020] [Accepted: 04/10/2020] [Indexed: 11/16/2022] Open
Abstract
Pseudoaneurysm formation is a rare complication after complex PCI with drug-eluting stents. Cardiologists and interventionist should be familiar with this rare complication after PCI and its management options.
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Affiliation(s)
- Mohammad Hasan Namazi
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Khani
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | - Fatemeh Abedi
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | - Isa Khaheshi
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
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13
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Giant right coronary artery aneurysm: Insights from the experience of a peripheral national health system institute. Hellenic J Cardiol 2020; 61:214-216. [DOI: 10.1016/j.hjc.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 11/23/2022] Open
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14
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Moidy MJ, Ibrahim OAM, Ali Khalifa EAI, Helmy SM. Right Atrial Pseudoaneurysm Complicating Epithelioid Hemangioendothelioma. Heart Views 2020; 21:104-108. [PMID: 33014303 PMCID: PMC7507911 DOI: 10.4103/heartviews.heartviews_96_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/04/2020] [Indexed: 11/30/2022] Open
Abstract
Cardiac pseudoaneurysm is uncommon among young adults with trauma. Infection, prior cardiac procedure, or cardiac operations are the most common reported causes. Right atrial pseudoaneurysm (RAPA) is extremely rare. Although often challenging to diagnose, advances in noninvasive imaging have improved the ability to diagnose cardiac pseudoaneurysms. We present a case of RAPA, highlighting the diagnostic accuracy of echocardiography in this rare entity.
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Affiliation(s)
| | - Osama Ali M Ibrahim
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Sherif Mahmoud Helmy
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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15
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Sozzi FB, Schiavone M, Maalouf JF, Gherbesi E, Zilocchi M, Canetta C, Colombo F. Acute cardiac disease in the postpartum: What to think. Echocardiography 2019; 36:2099-2102. [PMID: 31693236 DOI: 10.1111/echo.14524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/15/2019] [Indexed: 11/26/2022] Open
Abstract
A rare case of a spontaneous coronary artery dissection (SCAD) in the postpartum of a 32-year-old woman is presented. Pregnancy-related SCAD is a potentially life-threatening condition. SCAD is triggered by nonatherosclerotic disease, typically affects young-aged women and is still often underdiagnosed. Cardiac magnetic resonance is crucial to demonstrate the ischemic origin of the disease. A conservative management is generally preferred in stable SCAD as most dissected segments will heal spontaneously over a few months. Additionally, the percutaneous coronary intervention is associated with high rate of complications and procedural failure. The aim of this case was to improve awareness of SCAD and to advise clinicians seeking aid with patient management.
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Affiliation(s)
- Fabiola B Sozzi
- Cardiology Unit, Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, Italy
| | - Marco Schiavone
- Cardiology Unit, Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, Italy
| | - Joseph F Maalouf
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Elisa Gherbesi
- Cardiology Unit, Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, Italy
| | - Massimo Zilocchi
- Cardiology Unit, Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, Italy
| | - Ciro Canetta
- Internal Medicine Department, Ospedale di Crema, Crema, Italy
| | - Federico Colombo
- Cardiology Unit, Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, Italy
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16
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Systemic inflammatory activation in patients with acute coronary syndrome secondary to nonatherosclerotic spontaneous coronary artery dissection. North Clin Istanb 2019; 5:186-194. [PMID: 30688943 PMCID: PMC6323571 DOI: 10.14744/nci.2017.59244] [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: 06/06/2017] [Accepted: 09/20/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Pathological studies have suggested that local inflammation, particularly eosinophilic infiltration of the adventitia, could be related to nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD). However, the role of systemic inflammation in the pathogenesis of NA-SCAD remains unknown. Our aim was to investigate systemic inflammatory activation in patients with an acute coronary syndrome (ACS) secondary to NA-SCAD. METHODS The institutional electronic medical database was reviewed, and 22 patients with NA-SCAD-ACS were identified after the review. Furthermore, 30 random patients with CAD-ACS and 30 random subjects without any history of CAD or ACS with demographic and clinical characteristics similar to those of NA-SCAD-ACS patients were identified from the institutional database to be included in the study. RESULTS Patients with NA-SCAD-ACS and those with CAD-ACS both had higher white blood cell and neutrophil counts than controls. Neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels were only significantly higher in the NA-SCAD-ACS group [2.01 (1.54-6.17) for NLR and 0.70 (0.13-2.70) for CRP] than in the controls [1.55 (1.27-2.13), p=0.03 for NLR and 0.15 (0.10-0.43), p=0.049 for CRP]; however, there were no differences between the NA-SCAD-ACS and CAD-ACS groups [1.91 (1.41-2.78) for NLR and 0.41 (0.09-1.10) for CRP, p>0.05 for both comparisons] regarding all tested parameters. CONCLUSION The degree of inflammatory activation in NA-SCAD-ACS patients was similar to, or even greater than, that in CAD-ACS patients; thus, suggesting a role of inflammation in the pathophysiology of NA-SCAD-ACS.
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17
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Eosinophilic inflammation in spontaneous coronary artery dissection: A potential therapeutic target? Med Hypotheses 2018; 121:91-94. [DOI: 10.1016/j.mehy.2018.09.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/06/2018] [Accepted: 09/22/2018] [Indexed: 12/16/2022]
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18
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Cuenza LR, Comandante C, Gabitoya E, Razon TL. Right coronary artery fistula with giant pseudoaneurysm presenting as intrapericardial mass. J Cardiol Cases 2018; 17:190-193. [PMID: 30279889 DOI: 10.1016/j.jccase.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/21/2017] [Accepted: 01/26/2018] [Indexed: 12/17/2022] Open
Abstract
Coronary artery fistulas are rare congenital anomalies usually discovered incidentally on imaging studies. Coronary artery pseudoaneurysms are unusual complications of coronary artery fistulas, which can be due to atherosclerosis, inflammatory, traumatic or iatrogenic causes. We present a case of a 55 year old female with no known atherosclerotic risk factors, history of trauma or connective tissue disease referred because of recurrent palpitations. Work ups revealed a cardiac mass with an initial assessment of pericardial cyst. A multi modality approach of two dimensional echocardiography with Doppler studies, multidetector computed tomography and coronary angiogram revealed coronary artery fistula draining into a pericardial mass. The patient underwent surgical excision of the mass and ligation of the feeding vessel. Histopathology revealed features suggestive of a pseudoaneurysm. Postoperative course was uneventful and she was discharged stable and improved. Coronary artery fistula complicated by pseudoaneurysm is a rare clinical entity especially in patients without history of trauma or other risk factors. It can have an unusual presentation which can confound the diagnosis. Multimodality imaging is essential and adjunctive in order to determine a conclusive assessment. <Learning objective: Coronary artery pseudoaneurysm secondary to a congenital coronary artery fistula is an unusual cardiovascular pathology and can present as a rare diagnostic challenge for the clinician. This case emphasizes the importance of meticulous integration of both clinical assessment and complementary multimodality imaging approaches to better define the best therapeutic plan and facilitation of definitive surgical management.>.
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Affiliation(s)
- Lucky R Cuenza
- Department of Adult Cardiology, Philippine Heart Center, Philippines
| | | | - Ed Gabitoya
- Department of Vascular Medicine, Philippine Heart Center, Philippines
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Transcatheter Aortic Valve Replacement Incidentalomas: A Multimodality Imaging Case of Giant Right Coronary Aneurysm. Case Rep Cardiol 2018; 2018:9738530. [PMID: 29796318 PMCID: PMC5896253 DOI: 10.1155/2018/9738530] [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: 11/23/2017] [Revised: 02/15/2018] [Accepted: 03/03/2018] [Indexed: 11/17/2022] Open
Abstract
Giant coronary artery aneurysms (CAAs) are defined as having a diameter of greater than 2 cm. We report a case of an 82-year-old male with severe aortic stenosis incidentally diagnosed with giant right coronary artery aneurysm (gRCAA) while undergoing evaluation for transcather aortic valve replacement (TAVR). It was causing a mass effect on the right cardiac chambers but was otherwise asymptomatic. Our patient was successfully treated with surgical excision of aneurysm with concomitant coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR). The patient remained stable at discharge and on serial follow-ups for two years. In conclusion, due to the associated complication and increased risk of mortality with giant coronary aneurysms, we recommend surgical approach instead of medical management alone. We also call for evidence-based recommendations and guidelines for management of TAVR incidentalomas.
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20
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Spontaneous Coronary Artery Dissection in a Woman: Surgical Treatment and Angiographic Follow-Up. Ann Thorac Surg 2018; 106:e133-e135. [PMID: 29660360 DOI: 10.1016/j.athoracsur.2018.03.026] [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] [Received: 12/22/2017] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 11/23/2022]
Abstract
Spontaneous coronary artery dissection constitutes a rare entity that affects mostly women, especially those less than 40 years of age. Treatment of choice is a matter of discussion. It is suggested by many that the therapeutic strategy should be individualized based on each patient's clinical and angiographic manifestations. We present the case of a young woman who underwent surgical revascularization for dissection of the left main stem by using both internal thoracic arteries. Angiographic follow-up revealed resolution of the dissection, obstruction of the right internal thoracic artery graft, and reverse flow in the left internal thoracic artery graft.
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21
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Agrawal V, Kim ESH. Spontaneous Coronary Artery Dissection: Cardiac Manifestations of Vascular Disease. Prog Cardiovasc Dis 2018; 60:629-634. [PMID: 29630904 DOI: 10.1016/j.pcad.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 04/01/2018] [Indexed: 01/24/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS) in young women who otherwise do not have traditional risk factors for coronary artery disease. Though previously considered to be a rare occurrence and primarily associated with pregnancy, contemporary series have demonstrated that SCAD may account for 35% of ACS in women under the age of 50 years, and peripartum SCAD accounts for the minority of cases. Importantly, an association between SCAD and arterial abnormalities in non-coronary arterial distributions has been described. The most common of these arterial abnormalities is fibromuscular dysplasia. This manuscript will briefly review the epidemiology, diagnosis, and treatment of SCAD and provide an overview of how SCAD may be a cardiac manifestation of an underlying vascular disease in the majority of patients.
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Affiliation(s)
- Vineet Agrawal
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Esther S H Kim
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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22
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Matshela MR. Ischaemic heart disease and pregnancy: the tale of two stories. Cardiovasc J Afr 2018; 29:e8-e12. [PMID: 29583151 PMCID: PMC6008903 DOI: 10.5830/cvja-2017-050] [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: 08/17/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022] Open
Abstract
Ischaemic heart disease (IHD) is presumed to be rare in pregnancy. Based on that assumption, patients go undiagnosed or undertreated. IHD in pregnancy frequently occurs as a result of an unusual aetiology, therefore each patient needs to be managed individually since each may present differently. This may pose challenges to the consulting clinician. Pregnancy itself is a risk factor for cardiovascular disease, due to its associated hypercoagulable state. From current reports, the prevalence of IHD in females is increasing due to lifestyle changes, including cigarette smoking, diabetes and stress. In our modern societies, women delay childbearing until they are older, allowing time for risk factors to cluster. Although presumed to be rare in pregnant women, IHD is currently estimated to occur three to four times more often during pregnancy in middle– and high–income women, warranting an extensive review highlighting cases of IHD in pregnancy.
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Affiliation(s)
- Mamotabo R Matshela
- University of KwaZulu-Natal, Durban; Mediclinic Heart Hospital, Pretoria, South Africa; London School of Economics and Political Science, London, UK.
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23
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Lajus M, Gaufroy A. [Spontaneous coronary dissection, an unusual suspect]. Presse Med 2018; 47:211-214. [PMID: 29478793 DOI: 10.1016/j.lpm.2017.11.010] [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] [Received: 08/31/2017] [Revised: 11/04/2017] [Accepted: 11/27/2017] [Indexed: 11/25/2022] Open
Abstract
Under-diagnosed pathology. Especially in women under 60 without cardiovascular risk factor. Conventional coronary angiography without lesion. Association with fibrodysplasia being evaluated. Impact of IVUS and OCT. Conservative therapy.
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Affiliation(s)
- Mathieu Lajus
- CHU de Poitiers, bâtiment Beauchant, 86000 Poitiers, France.
| | - Astrid Gaufroy
- CHU de Poitiers, bâtiment Beauchant, 86000 Poitiers, France
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24
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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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25
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Zhou Z, Xu L, Zhang N, Wang H, Liu W, Sun Z, Fan Z. CT coronary angiography findings in non-atherosclerotic coronary artery diseases. Clin Radiol 2017; 73:205-213. [PMID: 28797768 DOI: 10.1016/j.crad.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/02/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022]
Abstract
Non-atherosclerotic coronary artery diseases are being increasingly recognised as causes of acute coronary events. Invasive coronary angiography frequently fails to identify the abnormalities in the proximal course of coronary arteries and coronary wall, while computed tomography coronary angiography (CTCA) allows for acquisition of more detailed information. CTCA serves as a reliable method for evaluating patients with non-atherosclerotic coronary artery diseases. The purpose of this article is to provide an overview of non-atherosclerotic abnormalities that may be demonstrated on CTCA.
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Affiliation(s)
- Z Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China
| | - L Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China.
| | - N Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China
| | - H Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China
| | - W Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China
| | - Z Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, WA 6845, Australia
| | - Z Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Rd, Chaoyang District, Beijing, 100029, China
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26
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Fang CT, Fang YP, Huang YB, Kuo CC, Chen CY. Epidemiology and risk factors of coronary artery aneurysm in Taiwan: a population based case control study. BMJ Open 2017; 7:e014424. [PMID: 28667203 PMCID: PMC5734584 DOI: 10.1136/bmjopen-2016-014424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Coronary artery aneurysm (CAA) is usually an asymptomatic and rare disease. There are limited epidemiological data for CAA in Asian populations and in the rest of the world. DESIGN A retrospective case control study. SETTING A population based, database study from Taiwan's National Health Insurance Research Database, between 2005 and 2011. PARTICIPANTS CAA patients identified using International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM) code 414.11 with CAA examinations. OUTCOME MEASURES The incidence rate and mortality rate of CAA were calculated. We also matched patients with non-CAA patients according to age, gender and index year at a 1:10 ratio to explore the risk factors for CAA using conditional logistic regression. RESULT A total of 1397 CAA patients were identified between 2005 and 2011; 41.9% were paediatric patients and 58.1% were adults. The incidence rate and mortality rate of CAA in Taiwan were 0.87 and 0.05 per 105 person-years, respectively. The adjusted odds ratios (aOR) for coronary atherosclerosis, hypertension, dyslipidaemia and diabetes were 7.97, 2.09, 2.48 and 1.51, respectively. Of note, aortic dissection (aOR 6.76), aortic aneurysm (aOR 5.82) and systemic lupus erythematosus (aOR 4.09) were found to be significantly associated with CAA. CONCLUSION In Taiwan, CAA patients were distributed across both paediatric and adult populations. Apart from cardiovascular risk factors, aortic diseases and systemic lupus erythematosus need to be investigated further in CAA patients.
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Affiliation(s)
- Chein-Tang Fang
- School of Pharmacy, Master Program in Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ping Fang
- School of Pharmacy, Master Program in Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yaw-Bin Huang
- School of Pharmacy, Master Program in Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chen-Chun Kuo
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chung-Yu Chen
- School of Pharmacy, Master Program in Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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27
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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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28
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Kar S, Webel RR. Diagnosis and treatment of spontaneous coronary artery pseudoaneurysm: Rare anomaly with potentially significant clinical implications. Catheter Cardiovasc Interv 2017; 90:589-597. [PMID: 28258964 DOI: 10.1002/ccd.26997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/17/2017] [Accepted: 01/28/2017] [Indexed: 12/20/2022]
Abstract
Spontaneous coronary artery pseudoaneurysm (PSA, false aneurysm) is an extremely rare occurrence with the precise incidence unknown. It is defined as an outwardly bulging monolayer or double layer within the coronary artery that lacks all 3 layers (intima, media, and adventitia) of the arterial wall. Coronary PSA commonly occurs from arterial dissection or perforation induced by catheter intervention, infection, pregnancy, or trauma. Traumatic dissection or perforation of the coronary artery after a percutaneous coronary intervention (PCI) remains the most common cause. Such cases may progress to myocardial ischemia, acute myocardial infarction, or acute coronary artery rupture causing death from cardiac tamponade. Intravascular ultrasound or cardiac computed tomography may aid in the diagnosis. Treatment options include PCI with a covered stent, bare or drug-eluting stent, coil embolization, coronary artery bypass graft with isolation of the PSA, or conservative management with vigilant clinical follow-up. In this review, we sought to describe the diagnosis, etiology, treatment, and the limited literature on spontaneous coronary artery PSA. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Subrata Kar
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas
| | - Richard R Webel
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri
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29
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Dai HL, Guang XF, Jiang LH, Xue Q, Zhang WH. Overlapping-Stent Intervention Treatment of a Giant Right Coronary Artery Pseudoaneurysm. JACC Cardiovasc Interv 2015; 8:e255-e256. [DOI: 10.1016/j.jcin.2015.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/16/2015] [Accepted: 07/31/2015] [Indexed: 10/22/2022]
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30
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Vatankulu MA, Sönmez O, Akkaya M, Aydin C. An Unusual Localization of a Cardiac Pseudoaneurysm Complicated by Paravalvular Leak in a Patient with Prosthetic Heart Valves. Echocardiography 2015; 33:330-2. [PMID: 26494458 DOI: 10.1111/echo.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Mehmet A Vatankulu
- Faculty of Medicine, Department of Cardiology, Bezmialem Vakıf University, Istanbul, Turkey
| | - Osman Sönmez
- Faculty of Medicine, Department of Cardiology, Bezmialem Vakıf University, Istanbul, Turkey
| | - Mehmet Akkaya
- Faculty of Medicine, Department of Cardiology, Bezmialem Vakıf University, Istanbul, Turkey
| | - Cemalettin Aydin
- Faculty of Medicine, Department of Cardiovascular Surgery, Bezmialem Vakıf University, Istanbul, Turkey
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31
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Honda T, Kawano H, Tsuneto A, Nakata T, Yoshida T, Koga S, Ikeda S, Abe K, Hayashi T, Yokose S, Eishi K, Maemura K. Coronary Artery Pseudoaneurysm due to Medial Mucoid Degeneration Mimicking an Intra-atrial Mass. Intern Med 2015; 54:2453-8. [PMID: 26424302 DOI: 10.2169/internalmedicine.54.3804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Coronary artery aneurysms are frequently asymptomatic and may be difficult to diagnose by cardiac imaging. We herein present a case of a coronary artery aneurysm of the right coronary artery due to medial mucoid degeneration mimicking an intra-atrial mass on echocardiography and magnetic resonance imaging, with the cause being diagnosed after surgery.
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Affiliation(s)
- Tomohiro Honda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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32
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Xing J, Li S, Zhang L, Yang Y, Duan Y, Li W, Zhou Y. Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest. Cardiovasc Pathol 2014; 24:241-3. [PMID: 25541181 DOI: 10.1016/j.carpath.2014.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 11/24/2014] [Accepted: 11/28/2014] [Indexed: 11/15/2022] Open
Abstract
Traumatic coronary pseudoaneurysm has been described to be mainly associated to iatrogenic lesion of the coronary arteries. However, chest-stab-wound-related coronary pseudoaneurysm caused by isolated partial incision of a coronary artery giving rise to fatal delayed cardiac tamponade is very rare. We describe an autopsy case in which this potentially fatal complication developed 8 days later after a thoracic stab wound. Unfortunately, the imaging examination failed to detect this defect during hospitalization. Postmortem examination revealed that the posterior wall of the left anterior descending coronary artery was intact but that the anterior wall was incised, forming a micropseudoaneurysm which had ruptured. This case highlights that isolated coronary artery injuries must be considered in any patient with a penetrating wound to the thorax, and coronary pseudoaneurysms should not be missed in these patients.
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Affiliation(s)
- Jingjun Xing
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Shangxun Li
- Department of Public Security of Hubei Province, NO.181 Xiongchu Avenue, Wuhan, 430070, RP China
| | - Lin Zhang
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Yi Yang
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Yijie Duan
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Wenhe Li
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Yiwu Zhou
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, PR China.
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33
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Crawley PD, Mahlow WJ, Huntsinger DR, Afiniwala S, Wortham DC. Giant coronary artery aneurysms: review and update. Tex Heart Inst J 2014; 41:603-8. [PMID: 25593524 DOI: 10.14503/thij-13-3896] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Giant coronary artery aneurysms are rare, with a reported prevalence of 0.02% to 0.2%. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease, and percutaneous coronary intervention. Most giant coronary artery aneurysms are asymptomatic, but some patients present with angina pectoris, sudden death, fistula formation, pericardial tamponade, compression of surrounding structures, or congestive heart failure. Clinical sequelae include thrombus formation, embolization, fistula formation, and rupture. Surgical correction is generally accepted as the preferred treatment for giant coronary artery aneurysms. We present an illustrative case of a giant 70 × 40-mm coronary artery aneurysm in a 56-year-old man who declined surgery and died one month later. In addition, we provide a review of the medical literature on giant coronary artery aneurysms.
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34
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Abstract
Eosinophilic coronary monoarteritis is an unfamiliar cause of acute myocardial ischemia. Most commonly, it presents as a left-sided chest pain or sudden death in middle-aged women with no traditional risk factors for coronary artery disease. Because the abrupt onset leaves almost no time for intervention, the symptoms readily lead to death, and most cases are diagnosed at necropsy. Dissection of the coronary artery wall with resultant occlusion of the lumen, which commonly affects the left anterior descending artery, is a consistent gross finding. An inflammatory infiltrate, which is predominantly composed of eosinophils in the tunica adventitia and tunica media and is often accompanied by a hematoma in between these 2 layers, is observed histologically. The etiology remains unclear, but an increase in the activity of eosinophils because of hormonal interactions during pregnancy has been suggested. Interplay of hormones is thought to culminate in the release of histolytic agents by the eosinophils, which initiate the dissection process. Currently, there is no specific treatment for eosinophilic coronary monoarteritis, but cyclophosphamide and prednisone have shown positive results in the treatment of spontaneous coronary artery dissection with unspecified periadventitial inflammation. Percutaneous coronary procedures have also resulted in favorable outcomes in a subset of patients. Because of the high, sudden death rate in eosinophilic coronary monoarteritis, deciphering the underlying pathophysiology of this almost invariably fatal disease remains both a challenge and a key to developing screening methods that will allow timely detection and thus treatment.
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Affiliation(s)
- Chrystalle Katte Carreon
- From the Department of Pathology & Laboratory Medicine, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York
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35
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Pontone G, Cavallotti L, Bertella E, Andreini D, Lualdi A, Alamanni F. An unusual presentation of giant right coronary artery pseudoaneurysm as a late complication of stent fracture treated by hybrid procedure: unusual presentation of stent rupture. JACC Cardiovasc Interv 2014; 7:e145-6. [PMID: 25240541 DOI: 10.1016/j.jcin.2014.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
| | - Laura Cavallotti
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Erika Bertella
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessandro Lualdi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesco Alamanni
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Nunes RAB, Cade JR, Silva RC, Brito Júnior FS, Freitas HFG. Spontaneous closure of post-intervention left anterior descending coronary pseudoaneurysm. Rev Port Cardiol 2014; 33:381.e1-4. [PMID: 25012824 DOI: 10.1016/j.repc.2014.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 02/27/2014] [Accepted: 03/01/2014] [Indexed: 11/25/2022] Open
Abstract
Coronary pseudoaneurysms are an unusual finding during coronary angiography and there are very little data on their prognosis in the literature. We report the case of a 62-year-old man admitted with an anterior myocardial infarction who developed a pseudoaneurysm in the mid left anterior descending artery some days after a type I coronary perforation during coronary angioplasty. Spontaneous closure of the pseudoaneurysm was observed during hospital follow-up. Spontaneous closure of coronary pseudoaneurysms may be more common in clinical practice than previously thought, but few cases have been reported. As the natural history of post-intervention coronary pseudoaneurysms has been little investigated, reports of their occurrence may help to clarify their evolution.
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Affiliation(s)
- Rafael A B Nunes
- Department of Cardiology, Hospital São Camilo Santana, São Paulo, Brazil; Heart Institute (InCor), University of São Paulo Medical School, Brazil.
| | - Jamil R Cade
- Department of Cardiology, Hospital São Camilo Santana, São Paulo, Brazil
| | - Rafael C Silva
- Department of Cardiology, Hospital São Camilo Santana, São Paulo, Brazil; Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | | | - Humberto F G Freitas
- Department of Cardiology, Hospital São Camilo Santana, São Paulo, Brazil; Heart Institute (InCor), University of São Paulo Medical School, Brazil
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Wang YC, Hsu RB, Huang CH. Spontaneous giant right coronary artery pseudoaneurysm. J Thorac Cardiovasc Surg 2014; 148:349-50. [DOI: 10.1016/j.jtcvs.2013.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
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38
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Spontaneous coronary artery dissection. Int J Cardiol 2014; 175:8-20. [DOI: 10.1016/j.ijcard.2014.04.178] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 02/19/2014] [Accepted: 04/17/2014] [Indexed: 02/03/2023]
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39
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Nunes RA, Cade JR, Silva RC, Brito Júnior FS, Freitas HF. Spontaneous closure of post-intervention left anterior descending coronary pseudoaneurysm. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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40
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A ballooning heart-giant left ventricular apical pseudoaneurysm presenting as congestive heart failure. J Thromb Thrombolysis 2014; 38:78-80. [PMID: 24497053 DOI: 10.1007/s11239-014-1054-9] [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: 10/25/2022]
Abstract
Left ventricular (LV) pseudo aneurysm is a contained rupture of ventricular wall by adherent pericardium or scar tissue. We present a case of a 70 year-old male presented with exertional dyspnea for 2 months and found to have giant LV pseudo aneurysm on transthoracic echocardiogram, cardiac MRI and angiogram. To our knowledge such a large pseudo aneurysm involving LV apex and presenting as congestive heart failure is the first case in literature.
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Hori D, Noguchi K, Nomura Y, Tanaka H. Enlarged coronary artery pseudoaneurysm after drug-eluting stent implantation. Asian Cardiovasc Thorac Ann 2013; 21:608-11. [DOI: 10.1177/0218492312461454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 73-year-old man with 2-vessel coronary artery disease underwent a staged percutaneous coronary intervention that resulted in rupture of the right coronary artery and pseudoaneurysm formation. Although the pseudoaneurysm regressed over a week, it reexpanded after a year. Resection of the pseudoaneurysm and coronary artery bypass grafting were performed. The drug-eluting stent at the coronary artery injury site may have delayed healing and remodeling of the artery, thus contributing to reexpansion of the pseudoaneurysm.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Fujigaoka Hospital, Showa University, Kanagawa, Japan
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery, Fujigaoka Hospital, Showa University, Kanagawa, Japan
| | - Yohei Nomura
- Department of Cardiovascular Surgery, Fujigaoka Hospital, Showa University, Kanagawa, Japan
| | - Hiroyuki Tanaka
- Department of Cardiovascular Surgery, Fujigaoka Hospital, Showa University, Kanagawa, Japan
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42
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Shahzad K, Cao L, Ain QT, Waddy J, Khan N, Nekkanti R. Postpartum spontaneous dissection of the first obtuse marginal branch of the left circumflex coronary artery causing acute coronary syndrome: a case report and literature review. J Med Case Rep 2013; 7:82. [PMID: 23510019 PMCID: PMC3608039 DOI: 10.1186/1752-1947-7-82] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 01/22/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Spontaneous coronary artery dissection is a rare but important cause of acute coronary syndrome. It can cause unstable angina, acute myocardial infarction, and sudden death. The condition commonly affects young females with about one-third of the cases occurring during pregnancy and the peripartum period. The diagnosis may occasionally be overlooked as the patients are often young and have no risk factors for coronary artery disease. CASE PRESENTATION Here we report the case of a 29-year-old African American woman who presented with acute coronary syndrome due to spontaneous dissection of the first obtuse marginal branch of the left circumflex coronary artery at three weeks post-partum and recovered requiring only medical management, possibly by longitudinal distribution of the intramural hematoma leading to good distal flow. CONCLUSIONS Spontaneous coronary artery dissection should be suspected in all young multiparous females presenting with chest pain in the peripartum period even in the absence of risk factors. Urgent diagnosis by angiography is required. It is recommended that treatment should be tailored to meet individual circumstances. Patients who present with single-vessel disease and hemodynamic stability, and who receive medical treatment with anticoagulation, nitrates and a beta-blocker, should experience good results.
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Affiliation(s)
- Khurram Shahzad
- Department of Internal Medicine, Division of Cardiology, East Carolina University, Brody School of Medicine, 600 Moye Boulevard, Greenville NC 27834, USA
| | - Long Cao
- Department of Internal Medicine, Division of Cardiology, East Carolina University, Brody School of Medicine, 600 Moye Boulevard, Greenville NC 27834, USA
| | - Quara Tul Ain
- Department of Internal Medicine, Division of Cardiology, East Carolina University, Brody School of Medicine, 600 Moye Boulevard, Greenville NC 27834, USA
| | - Jennifer Waddy
- Department of Internal Medicine, Division of Cardiology, East Carolina University, Brody School of Medicine, 600 Moye Boulevard, Greenville NC 27834, USA
| | - Nawazish Khan
- Department of Internal Medicine, Division of Cardiology, East Carolina University, Brody School of Medicine, 600 Moye Boulevard, Greenville NC 27834, USA
| | - Rajasekhar Nekkanti
- Department of Internal Medicine, Division of Cardiology, East Carolina University, Brody School of Medicine, 600 Moye Boulevard, Greenville NC 27834, USA
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Iatrogenic Giant Coronary Artery Pseudoaneurysm With “Daughter Aneurysm” Formation. J Thorac Imaging 2012; 27:W185-7. [DOI: 10.1097/rti.0b013e318255002c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Liu L, Li Z, He Y, Gu X, Nixon JVI. Coronary artery pseudoaneurysm following blunt trauma. J Card Surg 2012; 27:563-5. [PMID: 22748040 DOI: 10.1111/j.1540-8191.2012.01474.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 42-year-old male was admitted with persistent atypical chest pain following a motorcycle accident six months previously. A pseudoaneurysm, diagnosed by transthoracic echocardiography and computed tomography, was excised and the right coronary artery underwent bypass grafting.
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Affiliation(s)
- Lin Liu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Truesdell AG, Delgado GA, Li J, Abbott JD, Atalay MK, Singh AK. Challenges in the management of postpartum spontaneous coronary artery dissection. Interv Cardiol 2012. [DOI: 10.2217/ica.12.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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46
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Multidetector computed tomography diagnosis and cine imaging of left main coronary arterial dissection. J Thorac Imaging 2012; 27:W182-4. [PMID: 22627614 DOI: 10.1097/rti.0b013e318250ad2a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coronary artery dissection (CD) is a rare cause of acute myocardial ischemia. It is often diagnosed by invasive coronary angiography, which is the principal diagnostic tool and gold standard in the diagnosis and triage of patients with CD. More recently, electrocardiogram-gated multidetector computerized tomography has emerged as a complementary imaging tool primarily for follow-up purposes. To our knowledge, this is the first published report of the primary diagnosis and dynamic cine interrogation of a left main CD using retrospective electrocardiogram-gated multidetector computerized tomography, which was not disclosed on invasive coronary angiography.
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Abstract
Cardiac angiosarcoma is the most common of the cardiac sarcomas. It can infiltrate into adjacent structures in addition to seeding distant metastases. Coronary artery encasement is a rare but potentially life-threatening complication of cardiac angiosarcoma. We report a case of cardiac angiosarcoma encasing the right coronary artery with subsequent pseudoaneurysm formation with mural thrombus. Magnetic resonance first-pass, contrast-enhanced images are very useful for defining the communication between such lesions and underlying cardiac chambers. In the presence of distant metastases, there are limited treatment options. No intervention was attempted for the pseudoaneurysm, and thus far (12 mo) it has been stable.
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Chen YF, Chiang MH, Chang MS, Jong GP, Ting CT, Lee WL. An angiographically-documented rapidly growing left main coronary pseudoaneurysm treated by extracorporeal membrane oxygenator-assisted stent grafting without bypass surgery. Int J Cardiol 2012; 154:e8-10. [PMID: 21450353 DOI: 10.1016/j.ijcard.2011.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 03/05/2011] [Indexed: 10/18/2022]
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50
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Sasaguri S, Nishimori H, Wariishi S, Yamamoto M, Kondo N, Kihara K, Fukutomi T. A surgical case report of off-pump onlay patch grafting for pseudoaneurysm with diffusely calcified coronary artery. Ann Thorac Cardiovasc Surg 2011; 17:94-6. [PMID: 21587140 DOI: 10.5761/atcs.cr.09.01489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 11/11/2009] [Indexed: 11/16/2022] Open
Abstract
Coronary pseudoaneurysm usually occurs after catheter-based intervention as a result of traumatic dissection or perforation of a coronary artery in 4%-5% of cases. Here, we report the successful case of pseudoaneurysm occurring after percutaneous coronary angioplasty (PTCA) against the severely calcified coronary artery treated with off-pump long onlay patch bypass technique using internal thoracic arteries. We report the case of a 59-year-old woman treated with off-pump onlay patch grafting for pseudoaneurysm after coronary angioplasty against the diffusely calcified coronary lesion. The portion of the endoarterectomized left anterior descending coronary artery proximal to the resected aneurysm extending 5cm distally was successfully reconstructed with long onlay patch using the internal thoracic arterial graft.
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Affiliation(s)
- Shiro Sasaguri
- Department of Surgery II, Faculty of Medicine, Kochi University, Okoh-cho, Nankoku, Kochi, Japan.
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