Abstract O.18: Histopathological Analysis Of Sudden Death Adults With Coronary Artery Aneurysms

Histopathological study on coronary arterial lesions of adult autopsy cases who had a history of Kawasaki disease (KD) in childhood or who had coronary artery aneurysms (CAANs) was performed to analyze the relationship between post-inflammatory arterial lesions and atherosclerosis. Materials and Methods: Five autopsy cases who contracted KD at childhood and 11 autopsy cases who had giant CAANs at autopsy although a history of KD was not confirmed were included in this study. The age at death ranged from 18 to 57 years old. Forty-eight coronary artery (CA) branches from 16 autopsies were histologically examined focusing on the atherosclerosis which developed on the post-inflammatory lesions. Results: CAANs occurred in 30 arteries among 48 CA branches. CAANs were classified into 2 types; dilated CAANs (22 branches) and recanalized CAANs (8 branches). Dilated CAANs: The early atherosclerotic lesions, which corresponded to Type III or less of AHA classification, were seen in 16 CAs, and among them 6 branches had thrombotic luminal occlusion caused by the intimal erosion. On the other hand, the advanced atherosclerotic lesions corresponding to Type IV or more were observed in 6 of 22 branches and thrombotic occlusion of the lumen was observed in 5 of 6 CA branches. The cause of those thrombotic occlusion was estimated the rupture of atheroma. Recanalized CAANs: All atherosclerotic lesions developed in the recanalized CAANs were classified to the early lesions. Thrombotic occlusion was seen in 1 of 8 branches. Non-CAANs: There were 18 CAs with no aneurysm formation. The majority of Non-CAANs (16 of 18 branches) showed early atherosclerotic lesions (Type I or II), but 2 branches of 1 patient showed the advanced atherosclerotic lesion and the lumen was occluded by the fresh thrombus caused by intimal erosion. Conclusion: This histological study targeted at the post-inflammatory CA lesions in adult suggests two things: 1) Though advanced atherosclerotic lesions were often observed in the dilated CAANs, the atherosclerosis in the recanalized CAANs and Non-CAANs was still in early stage. 2) The erosion of the intima plays an important role in a formation of the thrombotic occlusion in the post-inflammatory arterial lesions even in adulthood.

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Giant right coronary artery aneurysm

Journal of Transcatheter Interventions ◽

10.31160/jotci202028a20200021 ◽

2020 ◽

Vol 28 ◽

pp. 1-3

Author(s):

Alexandre Bonfim ◽

Ronald Souza ◽

Sérgio Beraldo ◽

Frederico Nunes ◽

Daniel Beraldo

Keyword(s):

Coronary Artery ◽

Right Coronary Artery ◽

Coronary Artery Aneurysm ◽

Clinical Course ◽

Artery Aneurysm ◽

Giant Aneurysm ◽

Coronary Artery Aneurysms ◽

History Of ◽

Artery Disease ◽

The Right

Right coronary artery aneurysms are rare and may result from severe coronary disease, with few cases described in the literature. Mortality is high, and therapy is still controversial. We report the case of a 72-year-old woman with arterial hypertension, and a family history of coronary artery disease, who evolved for 2 months with episodes of palpitations and dyspnea on moderate exertion. During the evaluation, a giant aneurysm was found in the proximal third of the right coronary artery. The patient underwent surgical treatment with grafting of the radial artery to the right coronary artery and ligation of the aneurysmal sac, with good clinical course.

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Multiple Coronary Chamber Microfistulas or Persistent Thebesian Vessels?

Journal of Interdisciplinary Medicine ◽

10.1515/jim-2017-0061 ◽

2017 ◽

Vol 2 (3) ◽

pp. 262-265

Author(s):

Daniel Cernica ◽

Lehel Bordi ◽

Elena Beganu ◽

Ioana Rodean ◽

Imre Benedek

Keyword(s):

Coronary Artery ◽

Invasive Coronary Angiography ◽

Left Ventricular ◽

Vascular Network ◽

Bundle Branch Block ◽

Cardiac Chamber ◽

Atherosclerotic Lesions ◽

Left Ventricular Chamber ◽

History Of ◽

Gender Specific

Abstract Coronary fistulas are rare, not gender-specific congenital conditions, consisting of communications between the coronary arteries and either another coronary vessel or a cardiac chamber. In contrast to large fistulas, small fistulas, named “minimae cordis veneae” or the Thebesius venous system, are draining into heart chambers and form a vascular network in the cardiac lumen. In this article, we present the case of a 72-year-old female with a significant history of cardiovascular disease, admitted to our clinic because of rest dyspnea, fatigue, and minimal chest pain. The 12-lead electrocardiogram showed a trifascicular block (a second-degree atrioventricular block Mobitz II, associated with a right bundle branch block and left anterior fascicle block) and negative T waves in DII, DIII, aVF, V4–V6 leads. An invasive coronary angiography was performed, which revealed no significant atherosclerotic lesions. However, a persistent capillary blush was present at the apex site of the left ventricular chamber, draining from the distal segments of both the anterior descending coronary artery and the posterior interventricular coronary artery. The intramural vascular network generating a left ventricle angiogram image of this kind was suggestive for persistent Thebesian vessels connecting the two coronaries with the left ventricular chamber.

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Giant Coronary Artery Aneurysms Involving More Than One Coronary Artery

10.21203/rs.3.rs-353256/v1 ◽

2021 ◽

Author(s):

Matthew S Khouzam ◽

Nayer Khouzam

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Aortic Aneurysm ◽

Right Coronary Artery ◽

Coronary Artery Aneurysm ◽

Artery Aneurysm ◽

Coronary Artery Aneurysms ◽

St Segment ◽

History Of ◽

The Right

Abstract Background: Coronary artery aneurysms are rare findings in patients undergoing coronary angiography. The presence of multiple coronary artery aneurysms located in more than one coronary artery is even more uncommon. The pathophysiology of such aneurysms is unknown, but the majority are often due to atherosclerosis, congenital heart disease, or vasculitis. Case Presentation: We present a rare case of a 78-year-old female patient who presented with unstable angina and non-ST segment elevation myocardial infarction. On coronary angiography she was found to have three separate 1 cm saccular aneurysms involving the proximal left anterior descending coronary artery. The right coronary artery could not be visualized. Computed chest tomography revealed a 6.6 x 6.3 cm saccular aneurysm of the right coronary artery, and a 4.4 cm fusiform aneurysm of the ascending aorta. The patient gave no history of percutaneous coronary intervention or cardiac surgical procedures. She had a previous history of endovascular stenting of an abdominal aortic aneurysm. The sizable right coronary artery aneurysm showed extrinsic compression of both the right atrium and ventricle with right ventricular hypokinesis. Serological studies for vasculitis were all negative. Pathology of the aneurysm wall revealed calcific atherosclerosis without evidence of vasculitis. The patient underwent subtotal resection of the right coronary aneurysm with ligation of the proximal and distal ends of the right coronary artery and double bypass surgery to the left anterior descending and right posterior descending coronary arteries. Conclusion: The presence of multiple, large coronary artery aneurysms is very rare. Treatment can be challenging and should be individualized. Surgical treatment is recommended for giant coronary artery aneurysms to prevent potential complications. Keywords: coronary artery aneurysm, aortic aneurysm, atherosclerosis, non-ST segment 32 elevation myocardial infarction, case report

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Abstract 633: Macrophage SR-BI Suppresses Atherosclerosis by Modulation of Autophagy via VPS34/Belclin-1 Pathway

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.36.suppl_1.633 ◽

2016 ◽

Vol 36 (suppl_1) ◽

Author(s):

Huan Tao ◽

Patricia G Yancey ◽

John L Blakemore ◽

Youmin Zhang ◽

Lei Ding ◽

...

Keyword(s):

Foam Cell ◽

Oxidized Ldl ◽

Cell Formation ◽

Atherosclerotic Lesion ◽

Beclin 1 ◽

Foam Cell Formation ◽

Aortic Tissue ◽

Type I ◽

Macrophage Foam Cell ◽

Atherosclerotic Lesions

Background: Autophagy modulates vascular cell lipid metabolism, lipid droplet turnover, foam cell formation, cell survival and death, and inflammation. Scavenger receptor class B type I (SR-BI) deficiency causes impaired lysosome function in macrophages and erythrocytes. Methods and Results: Bone marrow transplantation studies were performed in ApoE and LDLR deficient mice to examine the effects of hematopoietic SR-BI deletion on atherosclerotic lesion autophagy. In addition, in vitro studies compared WT versus SR-BI -/- macrophages. Under conditions of cholesterol induced stress, the mRNA and protein levels of critical autophagy players including ATG5, ATG6/Belcin-1, ATG7 and LC3II were decreased by 37.8% to 84.6% (P<0.05 to 0.01) in SR-B1 -/- macrophages and atherosclerotic aortic tissue compared to controls. Electron microscopic analysis showed that SR-BI -/- versus WT macrophages had 80% fewer (P<0.05) autophagsomes in response to cholesterol enrichment. Macrophage SR-BI deficiency led to 1.8-fold (P<0.05) more lipid deposition and 2.5-fold more (P<0.01) apoptosis in response to oxidized LDL. Furthermore, hematopoietic SR-BI deletion caused 2.3 fold (P<0.05) more cell death in aortic atherosclerotic lesions compared to the WT control. Pharmacologic activation of autophagy did not reduce the levels of lipid droplets or cell apoptosis in SR-BI null macrophages vs WT control. WT peritoneal macrophages were used to examine SR-BI subcellular distribution and its interaction with VPS34/Beclin-1. In response to induction of autophagy, macrophage SR-BI was expressed in lysosomes and co-localized with LC3-II. Furthermore, we found that SR-BI directly interacted with the VPS34/Beclin-1 complex. Conclusions: SR-BI deficiency leads to defective autophagy and accelerates macrophage foam cell formation and apoptosis in experimental mouse atherosclerotic lesions. Macrophage SR-BI regulates expression of critical autophagy players and directly modulates autophagy via the VPS34/Beclin-1 pathway, identifying novel targets for the treatment of atherosclerosis.

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Abstract O.72: The Spectrum Of Cardiovascular Lesions Requiring Intervention In Young Adults After Kawasaki Disease

Circulation ◽

10.1161/circ.131.suppl_2.o72 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

John B Gordon ◽

Lori B Daniels ◽

Andrew M Kahn ◽

Matthew Vejar ◽

Chisato Shimizu ◽

...

Keyword(s):

Young Adults ◽

Coronary Artery ◽

Kawasaki Disease ◽

Vascular Inflammation ◽

Cardiovascular Complications ◽

Coronary Artery Aneurysms ◽

History Of ◽

Proximal Coronary Artery ◽

Cardiothoracic Surgeon ◽

Cardiovascular Interventions

Background: Coronary artery aneurysms resulting from vascular inflammation associated with Kawasaki disease (KD) in childhood may remain clinically silent until adulthood. Young adults presenting with large aneurysms, unstable angina, or myocardial infarction (MI) following KD in childhood present unique challenges to the interventional cardiologist and cardiothoracic surgeon. We present a range of management issues raised by this patient population. Methods: Participants who underwent cardiovascular interventions were identified from an observational cohort of 154 individuals with a history of KD enrolled in the San Diego Adult KD Collaborative. Of these 154 participants, 63 (40.9%) were originally diagnosed with KD and followed by one of the co-authors (JCB) and were designated as Cohort 1. The remaining 91 participants (Cohort 2) were referred by their physician or self-referred for participation in the study. Results: Of the 154 participants, 20 (12.9%; 2 from Cohort 1 and 18 from Cohort 2) underwent cardiovascular interventions: 9 had percutaneous interventions and 11 had surgery. Twelve participants had been diagnosed with KD in childhood, 7 had a history of a KD-compatible illness in childhood, and 1 had proximal coronary artery aneurysms compatible with KD. Fourteen participants were asymptomatic until experiencing a major cardiovascular event: 8 presented with an acute MI, 3 presented with angina, 1 presented with end-stage congestive heart failure requiring cardiac transplantation, and 2 presented with extremity claudication. Conclusions: Cardiovascular complications in individuals with a history of KD illustrate the following points: 1) Even small to moderate-sized aneurysms that “normalize” by echocardiography in childhood can lead to stenosis and thrombosis decades after the acute illness; 2) Coronary interventions without intravascular ultrasound may result in underestimation of vessel lumen diameter; 3) Failure to assess the extent of calcification may lead to suboptimal procedural outcomes, and 4) Patients with symptomatic peripheral aneurysms may benefit from endarterectomy or resection. Interventional cardiologists should be aware of the complications encountered in this growing population of young adults.

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Multi-vessel coronary artery aneurysms in a patient with Parry Romberg syndrome: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz103 ◽

2019 ◽

Vol 3 (3) ◽

Author(s):

Andrew Mehlman ◽

Jaymin Patel ◽

Christopher Bitetzakis ◽

Michael Berlowitz

Keyword(s):

Coronary Artery ◽

Underlying Mechanism ◽

Heart Catheterization ◽

Left Heart ◽

Coronary Artery Aneurysms ◽

Left Heart Catheterization ◽

History Of ◽

Parry Romberg Syndrome ◽

Vessel Coronary Artery

Abstract Background Coronary artery aneurysms (CAAs) are a very rare finding on coronary angiograms with multiple known aetiologies. Parry Romberg syndrome (PRS) is also a very rare disease, and the underlying aetiology remains unknown. We present a rare case of CAAs in a patient with PRS, and discuss possible implications regarding the primary pathophysiological cause for both of these diseases. Case summary A 48-year-old woman with a history of PRS presented with atypical and non-exertional chest pain. Initial evaluation demonstrated a rising troponin without associated electrocardiogram changes, and as such she was taken for left heart catheterization. Left heart catheterization demonstrated diffuse aneurysmal and ectatic disease of multiple coronary arteries. Further evaluation with magnetic resonance angiogram and autoantibody panel did not demonstrate other vascular anomalies or rheumatologic disease, respectively. She was treated with dual anti-platelet therapy and statin, and at 1 year follow-up, she had resolution of her symptoms. Discussion It has been postulated that the underlying mechanism causing CAA is intravascular inflammation. Parry Romberg syndrome is theorized to be a neurovasculopathy, as evidenced by cases of associated intracranial aneurysms. Intravascular inflammation may play a key pathological role in CAA, and an association between CAA and PRS may exist.

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Cyclophosphamide use in treatment of refractory Kawasaki disease with coronary artery aneurysms

Pediatric Rheumatology ◽

10.1186/s12969-021-00526-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Olha Halyabar ◽

Kevin G. Friedman ◽

Robert P. Sundel ◽

Annette L. Baker ◽

Margaret H. Chang ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Retrospective Chart Review ◽

Severe Neutropenia ◽

Rapid Progression ◽

Coronary Artery Aneurysms ◽

Multicenter Studies ◽

Primary Indication ◽

History Of ◽

Anti Inflammatory

Abstract Background Despite timely administration of IVIG, some patients with Kawasaki disease (KD) develop rapidly progressive or giant coronary artery aneurysms (CAA). Case presentation We describe our experience using cyclophosphamide (CYC) for the treatment of such cases as well as a review of the literature on the use of CYC in KD. Through a retrospective chart review of our KD population, we identified ten children treated for KD with intravenous CYC (10 mg/kg/dose) for one or two doses. Seven patients were male, the median age was 2.0 years (range 4 months − 5 years). All patients received initial IVIG between day 4–10 of illness. Other anti-inflammatory treatments administered before CYC included second IVIG (n = 9), corticosteroids (n = 10), infliximab (n = 4), cyclosporine (n = 2), and anakinra (n = 1). Median illness day at administration of the first CYC dose was 22.5 days (range:10–36 days). The primary indication for treatment with CYC for all patients was large or giant CAA and/or rapid progression of CAA. Three patients received a second dose of CYC (10 mg/kg) for progressively enlarging CAA. CAA did not progress after final CYC treatment. One patient with a history of neutropenia in infancy developed severe neutropenia 9 days after treatment with CYC, which recovered without intervention or complications. No patient developed infections or other serious toxicity from CYC. Conclusion In KD patients with severe and progressive enlargement of CAA despite anti-inflammatory therapy, CYC seemed to arrest further dilation and was well-tolerated. Future multicenter studies are needed to confirm our findings in this subgroup of KD patients.

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Giant coronary artery aneurysm as a feature of coronavirus-related inflammatory syndrome

BMJ Case Reports ◽

10.1136/bcr-2020-238740 ◽

2021 ◽

Vol 14 (7) ◽

pp. e238740

Author(s):

Kerrie Louise Richardson ◽

Ankita Jain ◽

Jennifer Evans ◽

Orhan Uzun

Keyword(s):

Coronary Artery ◽

Inflammatory Markers ◽

Coronary Artery Aneurysm ◽

Artery Aneurysm ◽

First Line ◽

Coronary Artery Aneurysms ◽

Giant Coronary Artery Aneurysm ◽

History Of ◽

Inflammatory Syndrome ◽

Pcr Test

A 5-month-old female infant was admitted to hospital with a history of fever and rash during the recent coronavirus pandemic. She had significantly elevated inflammatory markers and the illness did not respond to first line broad spectrum antibiotics. The illness was later complicated by coronary artery aneurysms which were classified as giant despite treatment with intravenous immunoglobulin, steroids and immunomodulators. The infant had COVID-19 antibodies despite an initial negative COVID-19 PCR test. This case highlights the association of atypical Kawasaki like illness and paediatric multisystem inflammatory syndrome-temporarily associated with COVID-19 infection.

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CORONARY ARTERIES DAMAGE FEATURES IN IN YOUNG AND MIDDLE-AGED MEN WITH MYOCARDIAL INFARCTION AND RECURRENT EPISODES OF ISCHEMIA

"Medical & pharmaceutical journal "Pulse" ◽

10.26787/nydha-2686-6838-2021-23-3-74-79 ◽

2021 ◽

pp. 74-79

Author(s):

Epifanov S.Yu. ◽

Sotnikov A.V. ◽

Nosovich D.V.

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Coronary Arteries ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Study Group ◽

Type I ◽

History Of

Relevance. Recurrent ischemic events (RIS) adversely affect the duration of treatment and the prognosis of myocardial infarction (MI). Aim. To evaluate the coronary arteries condition in men under 60 years old (y.o.) with RIS and MI to improve understanding of the mechanisms of development and prevention. Material and methods. The study included men 19-60 years old with type I of MI. Patients were divided into two age-comparable groups: I - study group, with RIS (early postinfarction angina pectoris and / or recurrent MI) - 26 patients; II - control, without them - 114 patients. A comparative assessment of angiographic data in the selected groups was performed. Results. Patients in the study group had a greater (15.5%) than in the control (7.9%; p = 0.01) history of coronary artery bypass surgery, the degree of infarction-related artery stenosis (96.9 ± 7.7 and 92.3 ± 10.8%, respectively; p = 0.02). The magnitude of the narrowing of the coronary artery was associated with the coefficient of atherogenicity (r = 0.87; p <0.05), end-systolic (r = 0.53; p <0.05) and diastolic (r = 0.6; p <0, 05) left ventricle (LV) sizes, glomerular filtration rate (r = -0.5; p <0.05) in the first hours of MI, creatinine in the first hours (r = 0.47; p <0, 05) and at the end of the third MI week (r = 0.65; p <0.05). Conclusions. In men under 60 y.о. with RIS during MI, the most pronounced association with a history of coronary artery bypass surgery and a greater lumen narrowing of the infarct-associated artery, which, in turn, increased with impaired renal function and lipid metabolism, and was also associated with LV dilatation.

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