RESUMO
The case is a 76-year-old woman. She was admitted to the hospital because of chest and back pain. Coronary angiography revealed a 62-mm giant coronary artery aneurysm originating from the left main trunk( LMT), and urgent surgery was performed. Coronary artery-pulmonary artery fistula along with coronary artery aneurysm was completely removed by surgery. In this case, the reconstruction strategy for the LMT was crucial. The aneurysm wall was completely resected, allowing the coronary artery to return to its original course, and the length of the LMT defect was <2 cm. We determined that anatomical reconstruction of the LMT was optimal and succeeded in replacing a short great saphenous vein corresponding to the length of the defect. The patient was discharged without any complications.
Assuntos
Aneurisma Coronário , Humanos , Idoso , Feminino , Aneurisma Coronário/cirurgia , Aneurisma Coronário/diagnóstico por imagem , Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Angiografia CoronáriaRESUMO
BACKGROUND: Although occlusion of the right coronary artery (RCA) is common in the remote stages of Kawasaki disease, revascularization of the RCA is challenging in children and is usually managed by observation without intervention. METHODS: Using adenosine-stress 13N-ammonia myocardial perfusion positron emission tomography, we evaluated coronary circulation in 14 patients (12 males) with RCA occlusion to identify ischemia (myocardial flow ratio < 2.0) in the RCA region and examined hemodynamics, cardiac function, and coronary aneurysm diameter. These variables were also compared in patients with/without RCA segmental stenosis (SS). RESULTS: There were five cases of ischemia in the RCA region. RCA myocardial blood flow (MBF) at rest was higher in patients with ischemia than in those without ischemia, but the difference was not significant (1.27 ± 0.21 vs. 0.82 ± 0.16 mL/min/g, p = 0.2053). Nine patients presented with RCA SS, and age at onset of Kawasaki disease tended to be lower in those with SS. The maximum aneurysm diameter of RCA was significantly smaller in patients with SS (10.0 ± 2.8 vs. 14.7 ± 1.6, p = 0.0239). No significant differences in other variables were observed between patients with/without ischemia and SS. CONCLUSIONS: At rest, MBF in the RCA region was relatively well preserved, even in patients with RCA occlusion, and there was no progressive deterioration in cardiac function. Adenosine stress showed microcirculatory disturbances in only half of the patients, indicating that it is reversible in children with Kawasaki disease.
Assuntos
Amônia , Circulação Coronária , Síndrome de Linfonodos Mucocutâneos , Imagem de Perfusão do Miocárdio , Radioisótopos de Nitrogênio , Tomografia por Emissão de Pósitrons , Humanos , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/fisiopatologia , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Masculino , Feminino , Amônia/sangue , Tomografia por Emissão de Pósitrons/métodos , Criança , Pré-Escolar , Imagem de Perfusão do Miocárdio/métodos , Oclusão Coronária/etiologia , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/fisiopatologia , Aneurisma Coronário/etiologia , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/fisiopatologia , Adolescente , Lactente , HemodinâmicaRESUMO
We report three cases of coronary artery aneurysm (CAA) in adults who presented with acute coronary syndrome. Two of these patients did not have traditional coronary artery disease risk factors. Management of CAA poses a significant challenge to interventionalists. We discuss the etiologic mechanisms, risk factors, pathophysiology, and diagnosis using angiography, intravascular ultrasound, and coronary computed tomography. We also highlight management options, including medical therapy and catheter-based interventions such as stenting, coil embolization, stent-assisted coil embolization, and surgical exclusion.
Assuntos
Síndrome Coronariana Aguda , Aneurisma Coronário , Angiografia Coronária , Humanos , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/terapia , Síndrome Coronariana Aguda/terapia , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/etiologia , Masculino , Resultado do Tratamento , Pessoa de Meia-Idade , Embolização Terapêutica , Ultrassonografia de Intervenção , Feminino , Idoso , Valor Preditivo dos Testes , Stents , Intervenção Coronária Percutânea/instrumentação , Angiografia por Tomografia Computadorizada , Fatores de RiscoRESUMO
A man in his 60s with paroxysmal atrial fibrillation was scheduled for a catheter ablation but was admitted to our department after contrast-enhanced CT showed a large homogeneous right atrial mass (52×52 mm) as well as a dilated right coronary artery (RCA). Coronary artery angiography showed a large fistula from the RCA to the mass in the right atrium. A giant coronary artery aneurysm was suspected and a surgical resection was performed. The mass was attached to the atrial septal wall and was palpated in the right atrium with a feeding artery from the RCA. The final diagnosis was an extremely rare case of giant coronary artery aneurysm originating from the RCA. The surgery was successful, and the patient was discharged 30 days later.
Assuntos
Septo Interatrial , Aneurisma Coronário , Angiografia Coronária , Humanos , Masculino , Aneurisma Coronário/cirurgia , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/diagnóstico , Septo Interatrial/diagnóstico por imagem , Septo Interatrial/cirurgia , Pessoa de Meia-Idade , Fibrilação Atrial/cirurgia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Tomografia Computadorizada por Raios X , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgiaRESUMO
A 60-year-old man with hypercholesterolemia and hypertension presented with acute coronary syndrome (SCA). The ECG showed lateral ischemia (T-wave inversion in V4-V6, D1 and aVL) and echocardiography showed normal left ventricular wall motion. Coronary angiography showed critical atherosclerotic lesions in the distal part of the left circumflex artery (LCx, culprit lesion), chronic total occlusion of the right coronary artery (RCA), significant but not critical stenosis in the middle part of left anterior descending artery (LAD), and a coronary artery to pulmonary artery (PA) fistula originating from the proximal part of the LAD and emptying into the PA via a coronary saccular aneurysm (12 x 12 x 10 mm). A multidetector row computed tomography angiography (CTA) confirmed the coronary artery fistula, which was treated with surgical approach. The patient underwent aneurysmorrhaphy with CAF closure and coronary artery bypass grafting on the RCA and LCx. The postoperative course was uneventful and the patient was discharged on postoperative day 14. CTA was useful for understanding the spatial relation of the CAF and the connection with the PA.
Assuntos
Fístula Artério-Arterial , Aneurisma Coronário , Artéria Pulmonar , Humanos , Masculino , Artéria Pulmonar/cirurgia , Artéria Pulmonar/diagnóstico por imagem , Pessoa de Meia-Idade , Fístula Artério-Arterial/cirurgia , Fístula Artério-Arterial/complicações , Aneurisma Coronário/cirurgia , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico por imagem , Ponte de Artéria Coronária/métodos , Angiografia CoronáriaAssuntos
Aneurisma Coronário , Embolização Terapêutica , Humanos , Resultado do Tratamento , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/cirurgia , Aneurisma Coronário/etiologia , Aneurisma Coronário/terapia , Masculino , Embolização Terapêutica/instrumentação , Ponte de Artéria Coronária/efeitos adversos , Angiografia Coronária , Idoso , Veia Safena/transplante , Veia Safena/diagnóstico por imagemRESUMO
In the absence of standardized management guidelines, coronary artery aneurysms (CAAs) present therapeutic challenges. Percutaneous coronary intervention (PCI) is rarely explored, especially in giant aneurysms with persistent angina, where surgery might be presumed as a preferred option. We describe the technical aspects and feasibility of PCI using Gore Viabahn expanded polytetrafluoroethylene (ePTFE)-covered nitinol self-expanding stents in a 66-year-old woman with a complex medical history and an enlarging, symptomatic right coronary artery aneurysm. The case was complicated by endoleak after the first stent, but intravascular ultrasound guidance enabled the precise deployment of additional stents, resulting in the successful exclusion of the aneurysm. This case demonstrates steps to successful CAA PCI with Gore Viabahn ePTFE-covered nitinol self-expanding stents and emphasizes that in unsuitable surgical candidates, PCI might be a potential alternative for symptomatic CAAs.
Assuntos
Ligas , Aneurisma Coronário , Desenho de Prótese , Ultrassonografia de Intervenção , Humanos , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/cirurgia , Aneurisma Coronário/terapia , Idoso , Feminino , Resultado do Tratamento , Stents Metálicos Autoexpansíveis , Angiografia Coronária , Politetrafluoretileno , Intervenção Coronária Percutânea/instrumentação , Stents , Angioplastia Coronária com Balão/instrumentaçãoRESUMO
Coronary artery aneurysms represent a rare pathology (0.2-4.9% of patients undergoing coronary angiography) that may reach considerable size. The clinical presentation is various, manifesting as acute coronary syndrome or, conversely, remaining silent lifelong. We here report the case of an incidental finding by transthoracic echocardiography of a paracardiac mass of considerable size in a patient with vasculopathy that underwent a Bentall procedure for acute aortic dissection 18 years earlier. On thoracic computed tomography angiography, a 62 mm-sized giant aneurysm located in the proximal right coronary artery was evidenced. The optimal treatment of patients affected by coronary artery aneurysms remains debated; therefore, the therapeutic strategy should be individualized considering the etiology, clinical presentation, anatomical characteristics and concomitant presence of obstructive coronary artery disease.
Assuntos
Aneurisma Coronário , Ecocardiografia , Achados Incidentais , Humanos , Aneurisma Coronário/cirurgia , Aneurisma Coronário/diagnóstico por imagem , Ecocardiografia/métodos , Masculino , Dissecção Aórtica/cirurgia , Dissecção Aórtica/diagnóstico por imagem , Idoso , Angiografia por Tomografia Computadorizada/métodosRESUMO
ABSTRACT: Aneurysmal dilation of coronary arteries is a rare condition detected during coronary angiography. Due to their poorly elucidated underlying mechanisms, their variable presentations, and the lack of large-scale outcome data on their various treatment modalities, coronary artery aneurysms, and coronary ectasia pose a challenge to the managing clinician. This case presentation provides insight into the challenges regarding the management of the coronary artery aneurysm during the perioperative period.
Assuntos
Aneurisma Coronário , Angiografia Coronária , Insuficiência da Valva Tricúspide , Humanos , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/complicações , Aneurisma Coronário/cirurgia , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgia , Masculino , Ecocardiografia Transesofagiana , Pessoa de Meia-Idade , FemininoAssuntos
Angiografia Coronária , Displasia Fibromuscular , Humanos , Displasia Fibromuscular/diagnóstico por imagem , Displasia Fibromuscular/complicações , Feminino , Angiografia por Tomografia Computadorizada , Valor Preditivo dos Testes , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/etiologia , Doenças Vasculares/cirurgia , Doenças Vasculares/congênito , Pessoa de Meia-Idade , Resultado do Tratamento , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/etiologia , Aneurisma Coronário/cirurgiaRESUMO
BACKGROUND: IgG4-related disease (IgG4-RD) is a recently recognized fibro-inflammatory disorder that can affect almost any organ. IgG4-RD has also been reported in coronary arteries as periarteritis. IgG4-related coronary periarteritis may cause coronary artery aneurysms, and IgG4-related coronary artery aneurysms (IGCAs) are life-threatening. We describe a case of a patient with IGCA that highlights the usefulness and limitations of various IGCA evaluation modalities and provides insight into disease pathophysiology. CASE SUMMARY: A 60-year-old man with IgG4-RD diagnosed 2 years before and with IGCA at the proximal right coronary artery (RCA) on coronary angiography (CAG) 9 months prior to admission to the hospital presented with acute coronary syndrome. Emergent CAG revealed the rapid progression of IGCA at the RCA, an obstruction of the diagonal branch, and stenosis of the left anterior descending artery (LAD) and the high lateral branch (HL). The patient underwent percutaneous coronary intervention for the diagonal branch. The RCA aneurysm was resected and bypassed with a saphenous vein graft (SVG); coronary bypass grafting (left internal mammary artery to LAD and SVG to HL) was performed. Pathological findings showed inflammatory cell infiltration and disruption of the elastic plate. CONCLUSION: IGCAs require careful follow-up with computed tomography scans for early detection of aneurysmal enlargement.
Assuntos
Aneurisma Coronário , Angiografia Coronária , Ponte de Artéria Coronária , Progressão da Doença , Doença Relacionada a Imunoglobulina G4 , Humanos , Masculino , Aneurisma Coronário/cirurgia , Aneurisma Coronário/imunologia , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/patologia , Pessoa de Meia-Idade , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/imunologia , Doença Relacionada a Imunoglobulina G4/cirurgia , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/patologia , Vasos Coronários/patologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/imunologia , Resultado do Tratamento , Intervenção Coronária Percutânea , Imunoglobulina G/sangueAssuntos
Aneurisma Coronário , Angiografia Coronária , Embolização Terapêutica , Stents , Ultrassonografia de Intervenção , Humanos , Masculino , Pessoa de Meia-Idade , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/terapia , Aneurisma Coronário/diagnóstico , Vasos Coronários/diagnóstico por imagem , Embolização Terapêutica/instrumentação , Resultado do TratamentoAssuntos
Angioplastia Coronária com Balão , Humanos , Masculino , Dissecção Aórtica/cirurgia , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/terapia , Angiografia Coronária , Resultado do Tratamento , Pessoa de Meia-Idade , Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/cirurgia , FemininoRESUMO
BACKGROUND: A coronary artery aneurysm (CAA) is an abnormal dilation of a coronary artery segment often accompanied by coronary artery fistula (CAF), leading to communication between a coronary artery and a cardiac chamber or a part of the coronary venous system. Both CAAs and CAFs can present with symptoms and signs of myocardial ischemia and infarction. CASE PRESENTATION: We describe the case of a 46-year-old woman with non-ST-elevation myocardial infarction (NSTEMI) caused by a "giant" CAA. Various imaging modalities revealed a thrombus-containing aneurysm located at the right-posterior cardiac border, with established arteriovenous communication with the distal part of left circumflex artery (LCx). After initial treatment with dual antiplatelet therapy, a relapse of pain was reported along with a new increase in troponin levels, electrocardiographic abnormalities, reduced left ventricular ejection fraction (LVEF) and thrombus enlargement. Surgical excision of the aneurysm was favored, revealing its true size of 6 cm in diameter. Τhe aneurysm was excised without complications. The patient remained asymptomatic during follow-up. CONCLUSIONS: Management of rare entities such as "giant" CAAs and CAFs can be challenging. Cases such as this can serve as precedents to facilitate treatment plans and develop consistent recommendations, emphasizing the importance of personalized strategies for future patients.
Assuntos
Fístula Arteriovenosa , Aneurisma Coronário , Doença da Artéria Coronariana , Infarto do Miocárdio , Trombose , Feminino , Humanos , Pessoa de Meia-Idade , Volume Sistólico , Função Ventricular Esquerda , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Trombose/complicações , Angiografia Coronária/métodosRESUMO
Giant coronary artery aneurysm (GCA) is a rare disease afflicting 0.2% of the population. It is primarily attributed to atherosclerosis in adults and Kawasaki disease in children. Other uncommon etiologies include Takayasu arteritis and post-percutaneous coronary intervention.1,2 GCA lacks a universally accepted definition, with proposed criteria including a diameter exceeding 2 cm, 5 cm, or four times the normal vessel size.3 While the majority of GCAs are asymptomatic, a subset of patients present with angina, myocardial infarction from embolization or compression, heart failure due to fistula formation, or even sudden death.1 We report a case of an adult harboring a GCA involving the right coronary artery.