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Woźniak P, Iwańczyk S, Błaszyk M, Stępień K, Lesiak M, Mularek-Kubzdela T, Araszkiewicz A. Coronary Artery Aneurysm or Ectasia as a Form of Coronary Artery Remodeling: Etiology, Pathogenesis, Diagnostics, Complications, and Treatment. Biomedicines 2024; 12:1984. [PMID: 39335497 PMCID: PMC11428638 DOI: 10.3390/biomedicines12091984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/19/2024] [Accepted: 08/29/2024] [Indexed: 09/30/2024] Open
Abstract
Coronary artery aneurysm or ectasia (CAAE) is a term that includes both coronary artery ectasia (CAE) and coronary artery aneurysm (CAA), despite distinct phenotypes and definitions. This anomaly can be found in 0.15-5.3% of coronary angiography. CAE is a diffuse dilatation of the coronary artery at least 1.5 times wider than the diameter of the normal coronary artery in a patient with a length of over 20 mm or greater than one-third of the vessel. CAE can be further subdivided into diffuse and focal dilations by the number and the length of the dilated vessels. Histologically, it presents with extensive destruction of musculoelastic elements, marked degradation of collagen and elastic fibers, and disruption of the elastic lamina. Conversely, CAA is a focal lesion manifesting as focal dilatation, which can be fusiform (if the longitudinal diameter is greater than the transverse) or saccular (if the longitudinal diameter is smaller than the transverse). Giant CAA is defined as a 4-fold enlargement of the vessel diameter and is observed in only 0.02% of patients after coronary. An aneurysmal lesion can be either single or multiple. It can be either a congenital or acquired phenomenon. The pathophysiological mechanisms responsible for the formation of CAAE are not well understood. Atherosclerosis is the most common etiology of CAAE in adults, while Kawasaki disease is the most common in children. Other etiological factors include systemic connective tissue diseases, infectious diseases, vasculitis, congenital anomalies, genetic factors, and idiopathic CAA. Invasive assessment of CAAE is based on coronary angiography. Coronary computed tomography (CT) is a noninvasive method that enables accurate evaluation of aneurysm size and location. The most common complications are coronary spasm, local thrombosis, distal embolization, coronary artery rupture, and compression of adjacent structures by giant coronary aneurysms. The approach to each patient with CAAE should depend on the severity of symptoms, anatomical structure, size, and location of the aneurysm. Treatment methods should be carefully considered to avoid possible complications of CAAE. Simultaneously, we should not unnecessarily expose the patient to the risk of intervention or surgical treatment. Patients can be offered conservative or invasive treatment. However, there are still numerous controversies and ambiguities regarding the etiology, prognosis, and treatment of patients with coronary artery aneurysms. This study summarizes the current knowledge about this disease's etiology, pathogenesis, and management.
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Affiliation(s)
- Patrycja Woźniak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznań, Poland
| | - Sylwia Iwańczyk
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznań, Poland
| | - Maciej Błaszyk
- Department of Radiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Konrad Stępień
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Prądnicka 80 Street, 31-202 Kraków, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznań, Poland
| | - Tatiana Mularek-Kubzdela
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznań, Poland
| | - Aleksander Araszkiewicz
- 1st Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznań, Poland
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Jurado-Román A, Tébar-Márquez D, Hernandez-Enríquez M, Birkemeyer R, Rodríguez-Leor O, Spinu R, Belle L, Galeote G, Jiménez-Valero S, Moreno R. Meta-long Papyrus: Meta-analysis of mid to long-term outcomes of PK Papyrus covered stent. Catheter Cardiovasc Interv 2024. [PMID: 39033331 DOI: 10.1002/ccd.31157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/26/2024] [Accepted: 07/13/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Although covered stents (CS) represent a potentially life-saving intervention for coronary perforation (CAP), their application has expanded to other contexts, including coronary aneurysms (CAA). However, data regarding mid- and long-term outcomes of CS in these settings scenarios remains limited. AIMS This meta-analysis aims to evaluate major adverse cardiac events (MACE) from discharge through long-term follow-up in patients undergoing percutaneous coronary intervention with the new generation polyurethane-covered cobalt-chromium PK Papyrus CS. METHODS We conducted a meta-analysis of data from three observational trials that included long-term follow-up of patients who underwent PK Papyrus CS implantation: Papyrus-Spain, SOS PK Papyrus, and PAST-PERF registry. RESULTS 332 patients underwent PK Papyrus CS implantation, 236 (71.1%) for CAP, 70 (21.1%) for CAA and 26 (7.8%) for other indications. After a mean follow-up of 16.2 months, the MACE was 14.3%, with Target Lesion Revascularization (TLR) being the most frequent (8.5%), followed by stent thrombosis (ST), 3.3% and cardiac death (CD), 2.6%. Comparing CAP and CAA subgroups, the MACE rate in CAA was significantly higher than CAP (21.4% vs 9.7%, p < 0.01), primary driven by ST (CAA: 8.6% vs CAP: 1.3%; p = 0.0015). CONCLUSIONS The clinical outcomes following PK Papyrus CS implantation are deemed acceptable, considering the challenging scenarios and the existing alternative treatments. However, MACE rates in patients with CAA who received Papyrus PK CS were significantly higher than in those with CAP, underscoring the importance of meticulous patient selection and optimization of CS in these complex patients and coronary anatomies.
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Affiliation(s)
- Alfonso Jurado-Román
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Daniel Tébar-Márquez
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | | | | | | | - Radu Spinu
- Cardiology Department, Hospital Of Annecy, Cannes, France
| | - Loïc Belle
- Cardiology Department, Hospital Of Annecy, Cannes, France
| | - Guillermo Galeote
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Santiago Jiménez-Valero
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
| | - Raúl Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
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Lu Y, Wang J, Ma L. A successful surgical management for a thrombosed giant left coronary aneurysm with right ventricular fistula in a young patient. Cardiol Young 2024:1-3. [PMID: 38618865 DOI: 10.1017/s1047951124000854] [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] [Indexed: 04/16/2024]
Abstract
Giant coronary aneurysm with ventricular fistula is rare. Due to the limited data from randomised clinical trials, therapeutic strategies for coronary aneurysms predominantly rely on on case series and anecdotal evidences. Reporting cases that provide practical experience in managing these aneurysms is therefore crucial. In this article, we report a rare case of a successful surgical management for a thrombosed giant left coronary aneurysm with right ventricular fistula, which is larger than any previously reported cases.
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Affiliation(s)
- Yunyi Lu
- Department of Medical Imaging, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Jing Wang
- Department of Medical Imaging, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Liheng Ma
- Department of Medical Imaging, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
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Rathinasamy R, Ghati N, Parakh N, Kumar S, Bisoi AK, Arava S, Narang R, Bhargava B. South African flag sign to a giant coronary artery aneurysm. Eur Heart J Case Rep 2024; 8:ytae028. [PMID: 38425727 PMCID: PMC10903159 DOI: 10.1093/ehjcr/ytae028] [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: 05/21/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
Background Coronary arteritis leading to aneurysm is one of the unusual presentations of IgG4-related disease. Acute myocardial infarction as a complication of IgG4-related giant coronary artery aneurysm is even rarer. Case summary We describe the case of a 56-year-old gentleman who presented to our institute with Canadian Cardiovascular Society (CCS) class III angina. His symptoms were persistent even with high-dose antianginal medications. He had an acute coronary syndrome two weeks back for which he was treated conservatively in a peripheral health centre. His 12-lead electrocardiogram at the time of the event was suggestive of high lateral ST-segment elevation myocardial infarction (South African flag sign). His transthoracic echocardiography showed mild left ventricular dysfunction and a large echogenic mass lateral to the left ventricle. Coronary angiography followed by cardiac computed tomography revealed a giant pseudoaneurysm of the proximal and mid-left anterior descending coronary artery. FDG-PET scan showed significant metabolic activity in the aneurysm wall and mediastinal lymph nodes suggesting active inflammation. IgG4-related coronary arteritis was suspected, and the patient underwent aneurysmectomy and coronary artery bypass (CABG) surgery. The histopathology of the resected segment showed diffuse IgG4-secreting plasma cells confirming the diagnosis. Discussion Atherosclerosis is the most common cause of coronary aneurysms in adults. However, cardiologists should be aware of atypical causes like IgG4-related disease that can even present with acute coronary syndrome. Although multimodality imaging is beneficial during early evaluation, histopathological analysis is the cornerstone for the diagnosis of IgG4-related disease. The management involves both immunosuppressive medication and endovascular or surgical repair.
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Affiliation(s)
- Rakavi Rathinasamy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nirmal Ghati
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neeraj Parakh
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sanjeev Kumar
- Department of Cardiac Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar Bisoi
- Department of Cardiothoracic Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajiv Narang
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Balram Bhargava
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
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Zayour M, Toufayli HY, Masri NW, Terro S, Chammas E. Coronary Artery Aneurysm: Its Evaluation in a 27-Year-Old Female Patient, Prognosis, and Suggested Treatment Strategies. Cureus 2023; 15:e47010. [PMID: 37965398 PMCID: PMC10642623 DOI: 10.7759/cureus.47010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Coronary artery aneurysm (CAA) is characterized by a localized dilation of one or more of the coronary arteries with multiple etiologies, including congenital, acquired, or connected to auto-inflammatory diseases with multiple shapes and classifications. It is usually diagnosed incidentally during coronary imaging and can have variable clinical outcomes, ranging from asymptomatic to sudden cardiac death with a generally poor prognosis. Management of this condition faces a clinical dilemma due to the lack of clear guidelines or randomized trials. Treatment should be individualized based on symptoms, shape, and comorbidities. Herein, we present the case report of a 27-year-old female patient with no prior medical conditions. However, she presented with palpitations, and a compressive mass located over the right atrium was identified in the patient. After undergoing cardiac catheterization and coronary scanning, a giant aneurysm of the sinoatrial branch was detected with an aneurysmal left main that was retrieved surgically with good recovery and postoperative course.
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Affiliation(s)
| | | | | | - Samer Terro
- Cardiology, Clemeceau Medical Center, Beirut, LBN
| | - Elie Chammas
- Cardiology, Clemeceau Medical Center, Beirut, LBN
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Khalid N, Ahmad SA. Editorial: Coronary artery aneurysms in chronic coronary syndromes. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 54:14-15. [PMID: 37150641 DOI: 10.1016/j.carrev.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/09/2023]
Affiliation(s)
- Nauman Khalid
- Section of Interventional Cardiology, St. Francis Medical Center, Monroe, LA, United States of America.
| | - Sarah Aftab Ahmad
- Section of Cardiothoracic Surgery, St. Francis Medical Center, Monroe, LA, United States of America
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Shyu TC, Wu CJ, Fu YC, Peng YC, Chuang TY, Kuo HC, Hsieh KS, Tai IH. Prevalence of antecedent Kawasaki disease in young adults with suspected acute coronary syndrome in high incidence cohort. Front Cardiovasc Med 2023; 10:1167771. [PMID: 37600029 PMCID: PMC10436480 DOI: 10.3389/fcvm.2023.1167771] [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: 02/16/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background Acute coronary syndrome (ACS) in early adulthood (<40 years old) may be associated with unrevealed diagnoses of Kawasaki disease (KD) in childhood. Daniels et al. showed that 5% of young adults with acute coronary syndrome might have antecedent Kawasaki disease in a cohort with Kawasaki disease incidence rates ranging from about 9 to 20 per 100,000 children under 5 years of age. However, there is no relevant research from the cohort with higher incidence rates (>80-100 per 100,000 children under 5 years of age) of Kawasaki disease. Methods We conducted a multicenter, retrospective study by reviewing medical records and angiographic data from two institutions (middle and southern Taiwan, respectively) of adults <40 years of age who underwent coronary angiography for clinically suspected acute coronary syndrome (2009-2019). Angiographic images were independently analyzed by three cardiologists who were blinded to the medical records. Demographic and laboratory data and risk factors of coronary artery disease were integrated to assess the likelihood of antecedent KD. Results All 323 young adults underwent coronary angiography, and 27 had coronary aneurysms. The patients' clinical and angiographic characteristics were evaluated, and 7.4% had aneurysms likely to be associated with KD. Most subjects were male (23/24), and their low-density lipoprotein (LDL) levels were significantly higher (p = 0.028) than those of subjects unlikely to have KD. Conclusion This study proposed that the cohort with higher Kawasaki disease incidence rates may have a higher prevalence of young adult ACS associated with antecedent KD. The importance of determining the clinical therapeutic significance of antecedent Kawasaki disease in young adult ACS warrants advanced research. Higher LDL levels may have a long-term cardiovascular impact in KD patients with persistent coronary aneurysms.
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Affiliation(s)
- Tsung-Cheng Shyu
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Yun-Ching Fu
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Chin Peng
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tzu-Yao Chuang
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Hsin Tai
- Department of Pediatric Cardiology, Structural/Congenital Heart Disease and Echocardiography Center, China Medical University Children’s Hospital, Taichung, Taiwan
- Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
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Yang LH, Cai RH, Wang LJ, He LP, Zhao XX. Coronary artery fistula with or without aneurysm: A large comparative study. Heliyon 2023; 9:e17414. [PMID: 37519741 PMCID: PMC10372208 DOI: 10.1016/j.heliyon.2023.e17414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 08/01/2023] Open
Abstract
Background The knowledge of coronary artery fistula (CAF) with coronary aneurysm mostly comes from case reports and is very limited. However, the management of CAF with and without aneurysm is different, more understanding of its clinical and imaging features is necessary. This is the first research focus on it through a large comparative study. Purpose To investigate the differences in imaging and clinical features of CAF with and without aneurysms. Methods We reviewed 96,037 consecutive patients undergoing coronary computed tomography angiogram (CCTA) between 2016 and 2020 and total of 429 CAF adult patients were enrolled. Those patients were divided into the CAF with aneurysm group (321 cases, 74.83%) and CAF without aneurysm group (108 cases, 25.17%) according to whether complicated with coronary aneurysm. Clinical baseline data, electrocardiographic (ECG) characteristics, the presence or absence of coronary atherosclerosis, complication symptoms and fistulous origin, entry site, number and diameter were analyzed. Chi-square test, T-test, Mann-Whitney U tests, and logistic regression analysis were performed. Results Most of the clinical baseline data did not differ significantly between the two groups (P > 0.05). However, heart murmur, coronary atherosclerosis, infective endocarditis (IE), fistulous diameter and fistulous entry site were significantly different (P<0.05). Further multivariate logistic regression analysis showed that large fistulous diameter and coronary-cardiac chamber arterial fistulas was dependent risk factors for CAF complicated with aneurysm. Conclusion CAF patients with aneurysm were more prone to develop heart murmur than those patients without aneurysm. Different from other sites of aneurysms, coronary atherosclerosis is more common in CAF without aneurysm. Larger fistulous diameter and coronary-cardiac chamber arterial fistula are dependent risk factors for CAF with aneurysms.
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Affiliation(s)
- Li-Han Yang
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China
| | - Ren-hui Cai
- Department of Radiology, Wuhan Asian Heart Hospital, China
| | - Lu-Jing Wang
- Department of Epidemiology and Biostatistics, School of Public Health of Kunming Medical University, China
| | - Li-Ping He
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China
| | - Xin-Xiang Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, China
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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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Gong X, Zhang H, Peng W, Yang G, Xiao Z. Case report: Multimodality imaging revealing ruptured giant coronary artery aneurysm presenting with hemoptysis. Front Cardiovasc Med 2023; 10:1185089. [PMID: 37293279 PMCID: PMC10244565 DOI: 10.3389/fcvm.2023.1185089] [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: 03/13/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023] Open
Abstract
Giant coronary artery aneurysm (CAA) is a relatively uncommon disease that is defined by a focal dilation of at least 20 mm and characterized by various clinical symptoms. However, cases presenting primarily with hemoptysis have not been reported. A man in his late 20 s suffering from persistent chest pain for over 2 months was transferred to our emergency department for intermittent hemoptysis lasting for 12 h. Bronchoscopy detected fresh blood in the left upper lobe bronchus without a definite bleeding source. Magnetic resonance imaging (MRI) demonstrated a heterogeneous mass and the high-intensity signals suggested active bleeding. coronary computed tomography (CT) angiography demonstrated a giant ruptured CAA wrapped in a large mediastinal mass Coronary angiography confirmed the CAA originating from the left anterior descending artery. The patient underwent an emergency sternotomy and an enormous hematoma arising from a ruptured CAA densely adhering to the left lung was identified. The patient recovered uneventfully and was discharged on the 7th day later. The ruptured CAA masquerading as hemoptysis highlights the indispensability of multimodality imaging for accurate diagnosis. Urgent surgical intervention is desirable in such life-threatening conditions.
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Affiliation(s)
- Xiangfeng Gong
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hongwei Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wanlin Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Yang
- Department of Medical Information and Engineering, College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Zhenghua Xiao
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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du Fretay XH, Aubry P. [Imaging of coronary aneurysms in adults' coronary aneurysms]. Ann Cardiol Angeiol (Paris) 2022; 71:391-398. [PMID: 36241480 DOI: 10.1016/j.ancard.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Coronary aneurysms are rare and of various etiologies in adults. Natural history, modalities of management and clinical monitoring remain poorly known due to the lack of large studies and homogeneous diagnostic and follow-up criteria in the published data. Coronary angiography is, so far, the most common diagnostic tool but can overlook some partially thrombosed aneurysmal. Intracoronary imaging, particularly intravascular ultrasound, can differentiate aneurysms from pseudoaneurysms considered by some to be at greater risk of events, requiring a curative treatment. Intracoronary imaging can also help with etiological assessment and percutaneous treatment. With its growing use in the search for coronary atheromatous disease, coronary CT angiography has become a major diagnostic tool for coronary aneurysms. In addition, that it can incidentally detect coronary aneurysms, coronary CT angiography is particularly useful for giant aneurysms poorly visualized on coronary angiography or less well evaluated by intracoronary imaging. It specifies their relationship with adjacent anatomical structures. It is also a non-invasive modality of monitoring. These three imaging tools are currently the most relevant in current practice pending large studies evaluating the natural history of coronary aneurysms, with the identification of possible risk factors that could modify the management.
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Affiliation(s)
- Xavier Halna du Fretay
- Département de Cardiologie, Hôpital Bichat Claude-Bernard, 75018, Paris, France; Cardioreliance, 45770, Saran, France.
| | - Pierre Aubry
- Département de Cardiologie, Hôpital Bichat Claude-Bernard, 75018, Paris, France; Service de Cardiologie, Centre Hospitalier de Gonesse, 95500, Gonesse, France
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Liu R, Gao X, Liang S, Zhao H. Five-years' prognostic analysis for coronary artery ectasia patients with coronary atherosclerosis: A retrospective cohort study. Front Cardiovasc Med 2022; 9:950291. [PMID: 36304544 PMCID: PMC9592902 DOI: 10.3389/fcvm.2022.950291] [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: 05/22/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Most of coronary artery ectasia (CAE) patients have comorbid coronary atherosclerosis. It was lack of prognostic data for CAE patients with coronary heart disease (CHD) and for whom with acute myocardial infarction (AMI). Objective To determine the overall prognosis for CAE patients. Materials and methods This study was a retrospective cohort study. Fifty-one patients with CAE and comorbid AMI (CAE + AMI) and 108 patients with CAE and comorbid CHD (CAE + CHD) were enrolled and matched to non-CAE subjects at a ratio of 1:3 using a propensity score method, respectively. Controls for CAE + AMI group were 153 AMI patients, controls for CAE group were 324 CHD patients and 329 participants with relatively normal coronary arteries (CON). We followed them up to observe major cardiovascular events (MACE). Results The Kaplan-Meier curves showed that the prognosis in CAE + AMI group was worse than in AMI group (5-year non-MACE rate: 62.70% vs. 79.70%, P = 0.010), the prognosis in CAE group was worse than in CHD and CON groups (5-year non-MACE rate: 74.10% vs. 85.80% and 96.70%, respectively, P = 0.000). The main MACEs in CAE + AMI and CAE groups were AMI reoccurrence (19.61% vs. 4.57%, P = 0.002) and re-hospitalization due to repeated angina pectoris (14.81% vs. 8.33% and 2.74%, P = 0.000), respectively. Additionally, the COX regression analysis revealed that the protective factors for preventing MACE in CAE + AMI group included antiplatelet agents (hazard ratio = 0.234, P = 0.016) and angiotensin-converting enzyme inhibitor/angiotensin receptor inhibitor (ACEI/ARB, hazard ratio = 0.317, P = 0.037). Whereas the main factor promoting MACE in CAE group was the degree of coronary stenosis (Gensini score, hazard ratio = 1.011, P = 0.022). Conclusion The prognosis of patients with CAE + AMI was worse than that of those with AMI. The overall prognosis of patients with CAE was worse than that of those with CHD. CAE + AMI and CAE groups had different characteristics; the former was prone to AMI reoccurrence, and the latter was prone to repeated angina pectoris. To prevent MACE, medications, including antiplatelets and ACEI/ARBs, are indicated for patients with CAE + AMI, whereas prevention of the progression of atherosclerotic lesions is indicated for patients with CAE.
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Giant Partially Thrombosed Coronary Aneurysm in Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 in Children. Case Rep Med 2022; 2022:3785103. [PMID: 36212082 PMCID: PMC9534692 DOI: 10.1155/2022/3785103] [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: 12/29/2021] [Revised: 06/27/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a postinfectious condition which usually develops 4 to 6 weeks after SARS-CoV-2 infection in a genetically predisposed individual. Clinical features are heterogeneous and include fever, respiratory compromise, mucocutaneous involvement with conjunctival abnormalities and erythematous exanthem, abdominal pain, and diarrhea. Neurologic and cardiovascular symptoms can also develop, including coronary artery dilatation. Some cases involve 2 or more organs and require critical admission. Echocardiography is the mainstay of cardiac evaluation in the acute setting as well as on outpatient follow-up. We present the case of a 4-month-old female with no past medical or surgical history who presented with a prolonged febrile syndrome associated with severe respiratory illness, gastrointestinal symptoms, and mucocutaneous abnormalities. Diagnosis of MIS-C was established based on clinical findings, persistently elevated markers of systemic inflammation and positive SARS-CoV-2 molecular test and evidence of prior SARS-CoV-2 infection with SARS-CoV-2 IgG positive. Echocardiogram evidenced myopericarditis and coronary aneurysms and patient was deemed candidate for immunomodulatory therapy with intravenous immunoglobulin (IVIg), resulting in favorable clinical and paraclinical outcomes. Few cases of giant coronary aneurysms have been reported in children. There are no existing literature reports about coronary thrombosis or thrombus formation resulting from vascular aneurysmal dilations in this population. As such, the prognosis and natural history of coronary artery aneurysms in the setting of MIS-C remain largely unknown.
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Matta A, Campelo-Parada F, Nader V, Lhermusier T, Bouisset F, Blanco S, Elbaz M, Roncalli J, Carrié D. Long-Term Outcomes of Conservative Versus Invasive Approach of Coronary Aneurysm. Rev Cardiovasc Med 2022; 23:281. [PMID: 39076619 PMCID: PMC11266970 DOI: 10.31083/j.rcm2308281] [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: 06/06/2022] [Revised: 06/19/2022] [Accepted: 07/07/2022] [Indexed: 07/31/2024] Open
Abstract
Introduction Up to date, the management of coronary artery aneurysm (CAA) is not well defined and depends on local heart team decision. Data reported in literature are scarce and controversial. We aim to compare the long-term outcomes of different therapeutic strategies of CAA (medical vs percutaneous coronary intervention (PCI) vs coronary artery bypass graft(CABG)). Materials and Methods A retrospective cohort study was conducted on 100 consecutive patients who underwent coronary angiography at Toulouse University Hospital, Toulouse France and fulfilled the diagnostic criteria of CAA. Coronary angiograms were reviewed, and all necessary data were collected. CAA was defined by a coronary dilation exceedingly at least 50% of reference coronary diameter. Results We identified 100 patients with CAA with a mean age of 67.9 ± 12 years. The left anterior descending coronary artery was most affected (36%). CAA is associated with significant coronary artery disease in 78% of cases. The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) was 13% during a median follow-up period of 46.2 ± 24 months. A 53% of patients underwent PCI or CABG. The rate of MACCE was lower in CABG group (9.1%) compared to PCI (14.3%) and medical (12.8%) groups, but without reaching statistically significant level. Longitudinal aneurysm diameter was positively linked to MACCE [OR = 1.109, 95% CI (1.014-1.214), p = 0.024]. No benefits have been attributed to anticoagulant regimen over antiplatelet therapy. Conclusions In our retrospective observational study, there seems to be no significant differences in MACCE-free survival between all groups (Medical vs PCI vs CABG). Larger longitudinal aneurysm diameter was identified as a predictor of poor prognosis during follow-up.
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Affiliation(s)
- Anthony Matta
- Department of Cardiology, Toulouse University Hospital (Hopital Rangeuil), 31400 Toulouse, France
- Department of Cardiology, Centre Hospitalier Intercommunal Castres-Mazamet, 81108 Castres, France
- Faculty of Sciences, Paul-Sabatier Toulouse III University, 31062 Toulouse, France
- Faculty of Medicine, Holy Spirit University of Kaslik, 446 Jounieh, Lebanon
| | - Francisco Campelo-Parada
- Department of Cardiology, Toulouse University Hospital (Hopital Rangeuil), 31400 Toulouse, France
| | - Vanessa Nader
- Department of Cardiology, Toulouse University Hospital (Hopital Rangeuil), 31400 Toulouse, France
- Faculty of Sciences, Paul-Sabatier Toulouse III University, 31062 Toulouse, France
| | - Thibault Lhermusier
- Department of Cardiology, Toulouse University Hospital (Hopital Rangeuil), 31400 Toulouse, France
| | - Frédéric Bouisset
- Department of Cardiology, Toulouse University Hospital (Hopital Rangeuil), 31400 Toulouse, France
| | - Stéphanie Blanco
- Department of Cardiology, Toulouse University Hospital (Hopital Rangeuil), 31400 Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Toulouse University Hospital (Hopital Rangeuil), 31400 Toulouse, France
- Faculty of Sciences, Paul-Sabatier Toulouse III University, 31062 Toulouse, France
| | - Jerome Roncalli
- Department of Cardiology, Toulouse University Hospital (Hopital Rangeuil), 31400 Toulouse, France
- Faculty of Sciences, Paul-Sabatier Toulouse III University, 31062 Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Toulouse University Hospital (Hopital Rangeuil), 31400 Toulouse, France
- Faculty of Sciences, Paul-Sabatier Toulouse III University, 31062 Toulouse, France
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Pan C, Gao Q, Kim BS, Han Y, Gao G. The Biofabrication of Diseased Artery In Vitro Models. MICROMACHINES 2022; 13:mi13020326. [PMID: 35208450 PMCID: PMC8874977 DOI: 10.3390/mi13020326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
As the leading causes of global death, cardiovascular diseases are generally initiated by artery-related disorders such as atherosclerosis, thrombosis, and aneurysm. Although clinical treatments have been developed to rescue patients suffering from artery-related disorders, the underlying pathologies of these arterial abnormalities are not fully understood. Biofabrication techniques pave the way to constructing diseased artery in vitro models using human vascular cells, biomaterials, and biomolecules, which are capable of recapitulating arterial pathophysiology with superior performance compared with conventional planar cell culture and experimental animal models. This review discusses the critical elements in the arterial microenvironment which are important considerations for recreating biomimetic human arteries with the desired disorders in vitro. Afterward, conventionally biofabricated platforms for the investigation of arterial diseases are summarized, along with their merits and shortcomings, followed by a comprehensive review of advanced biofabrication techniques and the progress of their applications in establishing diseased artery models.
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Affiliation(s)
- Chen Pan
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing 100081, China; (C.P.); (Q.G.)
- School of Mechanical Engineering, Beijing Institute of Technology, Beijing 100081, China;
| | - Qiqi Gao
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing 100081, China; (C.P.); (Q.G.)
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Byoung-Soo Kim
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan 626841, Korea
- Correspondence: (B.-S.K.); (G.G.)
| | - Yafeng Han
- School of Mechanical Engineering, Beijing Institute of Technology, Beijing 100081, China;
| | - Ge Gao
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing 100081, China; (C.P.); (Q.G.)
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
- Correspondence: (B.-S.K.); (G.G.)
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Sidhu NS, Kaur S. Double Whammy: Subacute Stent Thrombosis While Being Adherent to Dual Antiplatelet Therapy Including Ticagrelor, Followed by Multiple Coronary Artery Aneurysms in a COVID-19 Patient. Cureus 2022; 14:e21908. [PMID: 35273859 PMCID: PMC8901139 DOI: 10.7759/cureus.21908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), although predominantly a respiratory illness, can have important cardiovascular implications, which include the development of myocardial injury/myocarditis, acute coronary syndromes, arrhythmias, pericarditis, and the occurrence of arterial and venous thrombosis. We describe a rare case of a middle-aged COVID-19 patient who developed sub-acute stent thrombosis after implantation of second-generation drug-eluting stents (DES) despite being adherent to dual antiplatelet therapy including ticagrelor and who subsequently developed multiple coronary artery aneurysms within a few weeks of the DES implantation.
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