A challenging pacemaker implantation in the presence of a giant right coronary aneurysm compressing the right atrium

Giant coronary artery aneurysm is an uncommon disease, treated with surgical intervention or percutaneous coil embolization. A thrombosed aneurysm can cause extrinsic compression on the cardiac chambers, with potential hemodynamic effects and may cause problems when we need to implant a cardiac device. We present a case of difficult pacemaker implantation in a patient with 3 syncopes, first-degree AV block and complete left bundle branch block on electrocardiogram. The patient presented a giant aneurysm of the right coronary artery (85 x 90 mm), thrombosed, with right atrial compression. The pacemaker implantation was hampered by the difficulty of passing the lead through the compressed right atrium; indeed, only with simultaneous echocardiographic and fluoroscopic guidance, was it possible to complete the procedure. This case demonstrates the utility of echocardiogram, in particular settings, in cardiac stimulation procedures.

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Giant right coronary artery aneurysm complicated by a fistula to the right atrium, mimicking a ruptured sinus of Valsalva aneurysm

BMJ Case Reports ◽

10.1136/bcr-2018-226197 ◽

2018 ◽

pp. bcr-2018-226197

Author(s):

Masaki Kodaira ◽

Takahito Itoh ◽

Kiyoshi Koizumi ◽

Yohei Numasawa

Keyword(s):

Coronary Artery ◽

Right Coronary Artery ◽

Right Atrium ◽

Coronary Artery Aneurysm ◽

Artery Aneurysm ◽

Coronary Aneurysm ◽

Sinus Of Valsalva ◽

Sinus Of Valsalva Aneurysm ◽

Multiple Imaging ◽

The Right

Patients with a coronary aneurysm alone do not generally exhibit continuous murmurs; however, murmurs may be detected in the presence of a fistula. A 57-year-old woman with chest pain was referred to us with a suspected diagnosis of a ruptured sinus of Valsalva aneurysm owing to the presence of a continuous murmur that was detected on physical examination. However, CT revealed a giant right coronary artery aneurysm draining into the right atrium. Consequently, surgery was performed. This case highlights the importance of implementing multiple imaging modalities for adequate differential diagnoses of patients presenting with continuous murmurs.

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Lymph-node-first Kawasaki disease and giant coronary artery aneurysm

BMJ Case Reports ◽

10.1136/bcr-2018-226897 ◽

2019 ◽

Vol 12 (2) ◽

pp. bcr-2018-226897

Author(s):

Bazlin Ramly

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Artery Aneurysm ◽

Giant Aneurysm ◽

Coronary Aneurysm ◽

Acute Tonsillitis ◽

Old Irish ◽

Intravenous Antibiotics ◽

Giant Coronary Artery Aneurysm ◽

The Right

A 8-year-old Irish ethnicity girl presented with 3 days of fever with right-sided neck swelling which was first thought as acute tonsillitis with right-sided lymphadenitis. She was started on intravenous antibiotics. At day 7 of illness, she was diagnosed to have Kawasaki disease with clinical and biochemical evidence. Echocardiogram at day 9 of illness and subsequently CT cardiac angiogram performed revealed giant aneurysm at the right coronary artery with non-obstructing thrombus seen. The patient then commenced on clopidogrel and continued with a regular dose of aspirin. Due to the evidence of thrombus with a giant coronary aneurysm, she was also put on long-term warfarin therapy with regular monitoring of her international normalised ratio to be kept at the range of 2.0–3.0.

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A Case of Giant Coronary Artery Aneurysm in the Right Atrium Associated with a Right Coronary-Right Atrial Fistula

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.33.352 ◽

2004 ◽

Vol 33 (5) ◽

pp. 352-355

Author(s):

Motohiro Oshiumi ◽

Kazuhiro Hashimoto ◽

Hiroshi Okuyama ◽

Ryuichi Nagahori ◽

Gen Shinohara ◽

...

Keyword(s):

Coronary Artery ◽

Right Atrium ◽

Coronary Artery Aneurysm ◽

Artery Aneurysm ◽

Right Atrial ◽

Giant Coronary Artery Aneurysm ◽

The Right

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Giant Atrial Septal Artery Aneurysm with a Fistula to the Right Atrium

The Heart Surgery Forum ◽

10.1532/hsf.4031 ◽

2021 ◽

Vol 24 (5) ◽

pp. E781-E784

Author(s):

Bo Mei ◽

Guangjie He ◽

Xiong Tan ◽

Weitao Jin ◽

Yaxi Zhao ◽

...

Keyword(s):

Coronary Artery ◽

Cardiac Ct ◽

Three Dimensional ◽

Artery Aneurysm ◽

Coronary Aneurysm ◽

Right Atrial ◽

Coronary Artery Angiography ◽

Dimensional Reconstruction ◽

Current Article ◽

The Right

An atrial septal artery aneurysm is a rare disease, especially accompanied with a fistula. During clinical practice, it is very important to clear the anatomical details of the coronary aneurysm before operation. In the current article, we report a giant atrial septal artery aneurysm originating from a branch of the RCA combined with a coronary right atrial fistula. The coronary artery aneurysm should be evaluated using multiple diagnostic and imaging modalities, such as echocardiography, coronary artery angiography, magnetic resonance imaging, and cardiac CT, especially three-dimensional reconstruction, which could help us to distinguish the physiological and anatomical characteristics of the CAA and fistula.

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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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Assessing the Relationship Between Right Atrial Stiffness and Chamber Pressure to Quantitatively Define Myocardial Tensile Properties

2017 Design of Medical Devices Conference ◽

10.1115/dmd2017-3491 ◽

2017 ◽

Author(s):

Alexander R. Mattson ◽

Michael D. Eggen ◽

Vladimir Grubac ◽

Paul A. Iaizzo

Keyword(s):

Right Atrium ◽

Right Atrial ◽

Chamber Pressure ◽

Detailed Knowledge ◽

Cardiac Device ◽

Clinical Procedures ◽

Tensile Forces ◽

Pacemaker Leads ◽

Right Atrial Appendage ◽

The Right

Developing a successful cardiac device requires detailed knowledge of cardiac mechanical properties. For example, tissue failure characteristics and compliance feed into design criteria for many pacemaker leads (Zhao et al., 2011). In the right atrium, tensile forces are exerted on the right atrial appendage in multiple clinical procedures. In a traditional lead implant, mechanical manipulations with a stylet aid a clinician in assessing lead fixation, with a seldom used “tug” test providing additional input. Atrial lead dislodgement remains one of the top complications for bradycardia pacing leads (Chahuan et al., 1994), in part because there is no standard mechanical assessment at implant to verify fixation. Thus, a deeper understanding of forces exerted on the atrium during implant, is fundamental to understanding the problem. Further characterization of the biomechanics relevant to atrial device implants will provide valuable design input for fixation tests and help drive research toward new atrial fixation mechanisms. This study aims to better define the relationships between right atrial stiffness and the chamber pressures within the right atrium, so to characterize the link between tensile displacement within the right atrium, and the force exerted on an implanted device in a functional heart. These experiments quantitatively define the fixation force of a fixed cardiac device with a given pulled displacement; i.e. displacing the device a given distance will effectively ensure the experimentally derived fixation force.

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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.

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