Giant coronary artery aneurysms involving more than one coronary artery: case report

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 × 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.

Download Full-text

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.

Download Full-text

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

Download Full-text

Technical Considerations of Giant Right Coronary Artery Aneurysm Exclusion

Case Reports in Surgery ◽

10.1155/2016/3795640 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

James Barr ◽

Metesh Nalin Acharya ◽

Antonios Kourliouros ◽

Shahzad Gull Raja

Keyword(s):

Coronary Artery ◽

Right Coronary Artery ◽

Coronary Artery Aneurysm ◽

Surgical Repair ◽

Saphenous Vein Graft ◽

Artery Aneurysm ◽

Coronary Artery Aneurysms ◽

Coronary Aneurysms ◽

Right Ventricular Strain ◽

The Right

Giant coronary artery aneurysms are rare clinical entities. We report the case of a 49-year-old man who presented with dyspnoea and exertional chest pain. Investigations confirmed an aneurysmal right coronary artery measuring 4 cm with a fistulous communication to the right atrium. Following right atriotomy, the fistula was oversewn and the aneurysmal right coronary artery ligated at its origin and at several points along its course. A saphenous vein graft was anastomosed to the posterior descending artery. Persistent ventricular fibrillation occurred upon chest closure, attributed to ischaemia following ligation of the aneurysmal coronary artery. Emergent resternotomy and internal defibrillation were successfully performed. The sternum was stented open to reduce right ventricular strain and closed the following day. The patient made an unremarkable recovery. We here address the technical challenges associated with surgical repair of right coronary aneurysms and the physiology and management of potential complications.

Download Full-text

Abstract 141: A Case of Kawasaki Disease with Re-dilatation of a Coronary Artery Aneurysm after Regression

Circulation ◽

10.1161/circ.131.suppl_2.141 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Kensuke Oka ◽

Takaomi Minami ◽

Tatsuya Anzai ◽

Sadahiro Furui ◽

Akiko Yokomizo ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Coronary Angiography ◽

Artery Aneurysm ◽

Circumflex Artery ◽

Left Circumflex Artery ◽

Coronary Ct ◽

History Of ◽

The Right

Background: In patients with Kawasaki disease (KD), re-dilatation of coronary artery lesions (CAL) after regression is very rare. Here we report a case of KD with CAL re-dilatation after regression. Case report: A 15-year-old boy was diagnosed with KD at 1 year of age and was treated with intravenous immunoglobulin (IVIG, 400 mg/kg х 5 days). On day 14, echocardiography revealed CAL on the right coronary artery (RCA) and left coronary artery (LCA). Coronary arteriographic findings were as follows: segment 1, 3 mm in diameter; segment 6, 5 mm in diameter. He was prescribed aspirin, ticlopidine, and warfarin for 3 years. When he was 3 years old, coronary angiography showed complete CAL regression. His medications were discontinued and he underwent routine follow-up by echocardiography on which the CAL were not seen. At 14 years of age, coronary CT revealed re-dilatation of the LCA. Coronary angiography showed the same findings: 7 mm in diameter at the bifurcation between the LAD and the left circumflex artery, while the other regions were intact. He restarted aspirin and warfarin. The mechanism of CAL re-dilatation remains unclear; however, it is very important to follow patients carefully and routinely using echocardiography and/or coronary computed tomography, especially in cases with a history of CAL.

Download Full-text

Treatment of Left Anterior Descending Artery Aneurysm

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2006.3113 ◽

2008 ◽

Vol 6 (4) ◽

pp. 22-24

Author(s):

Mirsad Kacila ◽

Marco L.S. Matteucci ◽

Stefano Bevilacqua ◽

Nermir Granov ◽

Mattia Glauber

Keyword(s):

Coronary Artery ◽

Right Coronary Artery ◽

Artery Aneurysm ◽

Surgical Revascularization ◽

Coronary Artery Aneurysms ◽

Off Pump ◽

Left Anterior Descending Artery ◽

Coronary Aneurysms ◽

The Right

Coronary artery aneurysms (CAAs) are rare and their management is controversial. Their incidence varies from 1,5% to 5% of the coronary angiographies, with predilection of the right coronary artery. Unruptured coronary aneurysms are often silent and may remain undiagnosed. The etiology can be either congenital or acquired. We describe a case of a left anterior descending artery (LAD) aneurysm treated with an off-pump surgical revascularization with a LIMA to LAD without exclusion or ligature of the aneurysm.

Download Full-text

Correlation between ECG and coronary angiography in patients with a sudden obstruction of the right coronary artery (RCA)—physiological and pathological myocardial remodeling

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2013.05.068 ◽

2013 ◽

Vol 46 (4) ◽

pp. e18-e19

Author(s):

S. Sclarovsky ◽

K. Nikus ◽

Z.Q. Zhan ◽

F.J. Feminia

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Right Coronary Artery ◽

Myocardial Remodeling ◽

The Right

Download Full-text

Could the Novel Oral Anticoagulants Be Used for Coronary Artery Aneurysm?

Case Reports in Medicine ◽

10.1155/2020/5073814 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Quanxiang Yan ◽

Libing Ning ◽

Yu Jian ◽

Wencong Yang ◽

Qinghua Yuan ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Coronary Artery Aneurysm ◽

Left Main Coronary Artery ◽

Oral Anticoagulants ◽

Artery Aneurysm ◽

Antiplatelet Agents ◽

Novel Oral Anticoagulants ◽

The Novel ◽

Coronary Artery Aneurysms

Coronary artery aneurysms (CAAs) are uncommon in coronary angiography, and left main coronary artery aneurysms are rare. There is no consensus for the treatment of CAAs. A young patient with left coronary artery aneurysm diagnosed by coronary angiography and with recurrent acute myocardial infarction was treated with rivaroxaban and aspirin. The patient had no angina for 6 months. Novel oral anticoagulants combined with antiplatelet agents may be appropriate for the treatment of CAAs.

Download Full-text

A right coronary artery aneurysm 16 years after surgical repair of anomalous origin of the right coronary artery from the pulmonary artery

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivy356 ◽

2019 ◽

Vol 29 (1) ◽

pp. 157-158

Author(s):

Akira Furutachi ◽

Kojiro Furukawa ◽

Aiko Komatsu ◽

Eijiro Nogami

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Right Coronary Artery ◽

Surgical Repair ◽

Artery Aneurysm ◽

Anomalous Origin ◽

Artery Graft ◽

Long Term Follow Up ◽

The Right

Abstract Anomalous origin of the right coronary artery (RCA) from the pulmonary artery is a very rare congenital heart disease, and several reports have described long-term events after surgery. We report the case of a 46-year-old woman who underwent reimplantation of the RCA for anomalous origin of the right coronary artery from the pulmonary artery 16 years ago. An RCA aneurysm gradually developed and dilated over time, and we resected the aneurysm and also grafted the right gastroepiploic artery graft to the distal RCA. Careful long-term follow-up is required to avoid overlooking such a rare but life-threatening complication after surgical repair of anomalous origin of the right coronary artery from the pulmonary artery.

Download Full-text

Giant right coronary artery aneurysm. Case Report

Case reports ◽

10.15446/cr.v6n1.82446 ◽

2020 ◽

Vol 6 (1) ◽

pp. 70-76

Author(s):

Benjamín Iván Hernández-Mejía ◽

Edison Ricardo Espinoza-Saquicela

Keyword(s):

Coronary Artery ◽

Right Coronary Artery ◽

Coronary Revascularization ◽

Artery Aneurysm ◽

Coronary Aneurysm ◽

Moderate Hypothermia ◽

Coronary Catheterization ◽

Coronary Syndrome ◽

Coronary Aneurysms ◽

The Right

Introduction: Coronary aneurysms are rare and are linked to drug abuse; symptomatology depends on the coronary anatomy. This is a case of acute coronary syndrome associated with a giant right coronary aneurysm.Case description: A 40-year-old male, with history of heroin and crack use since age 20, attended consultation due to dyspnea, stable angina and diaphoresis. An electrocardiogram showed ST segment overlay on the underside and troponin problems. A coronary catheterization was performed, which revealed apparent inconclusive aortato-right atrium fistula. Based on the findings, angiotomography and magnetic resonance imaging were performed, finding a giant right coronary aneurysm. The aneurysm was resected using extracorporeal circuit, femoral cannulation, moderate hypothermia, aortic cross-clamping and cardioplegia, and the right coronary artery was revascularized with the left internal saphenous vein. The patient had a satisfactory postoperative period and was discharged after 7 days.Conclusion: There is an important association between drug use and the development of coronary aneurysms. Aneurysm size makes diagnosis difficult, so complementary studies are necessary to establish a differential diagnosis. An appropriate surgical approach allows for a complete resection of the aneurysm and optimal coronary revascularization.

Download Full-text