ABSTRACT
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.
Subject(s)
Coronary Aneurysm , Humans , Aged , Female , Coronary Aneurysm/surgery , Coronary Aneurysm/diagnostic imaging , Coronary Vessels/surgery , Coronary Vessels/diagnostic imaging , Coronary AngiographyABSTRACT
In this case report, we describe the surgical treatment of a right coronary sinus aneurysm. A 69-year-old male patient was screened because of palpitations. He was finally diagnosed with an aneurysm of the sinus of Valsalva of the right coronary cusp. According to current aortic guidelines, surgical reconstruction was proposed. The patient underwent a cardiac operation through a median sternotomy under routine cardiopulmonary bypass. After aortic cross-clamping, the aorta was opened and the connection between the aorta and the aneurysm was clearly visualized, underneath the ostium of the right coronary artery. After excision of the right coronary button and the remaining right coronary sinus wall, this sinus was reconstructed with a Dacron graft, with subsequent coronary reimplantation. The postoperative course was uneventful. The patient was discharged on postoperative day 7. A complete sinus reconstruction was preferred over local patching of the defect because of the proximity of the aneurysm sac to the right coronary artery and the fragile, thin aortic tissue just underneath the coronary ostium.
Subject(s)
Coronary Sinus , Humans , Male , Aged , Coronary Sinus/surgery , Sinus of Valsalva/surgery , Coronary Aneurysm/surgery , Coronary Aneurysm/diagnosis , Blood Vessel Prosthesis Implantation/methods , Treatment Outcome , Cardiopulmonary Bypass/methodsABSTRACT
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.
Subject(s)
Arterio-Arterial Fistula , Coronary Aneurysm , Pulmonary Artery , Humans , Male , Pulmonary Artery/surgery , Pulmonary Artery/diagnostic imaging , Middle Aged , Arterio-Arterial Fistula/surgery , Arterio-Arterial Fistula/complications , Coronary Aneurysm/surgery , Coronary Aneurysm/complications , Coronary Aneurysm/diagnostic imaging , Coronary Artery Bypass/methods , Coronary AngiographySubject(s)
Coronary Aneurysm , Embolization, Therapeutic , Humans , Treatment Outcome , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/surgery , Coronary Aneurysm/etiology , Coronary Aneurysm/therapy , Male , Embolization, Therapeutic/instrumentation , Coronary Artery Bypass/adverse effects , Coronary Angiography , Aged , Saphenous Vein/transplantation , Saphenous Vein/diagnostic imagingABSTRACT
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.
Subject(s)
Atrial Septum , Coronary Aneurysm , Coronary Angiography , Humans , Male , Coronary Aneurysm/surgery , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/diagnosis , Atrial Septum/diagnostic imaging , Atrial Septum/surgery , Middle Aged , Atrial Fibrillation/surgery , Heart Atria/diagnostic imaging , Heart Atria/pathology , Tomography, X-Ray Computed , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgeryABSTRACT
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.
Subject(s)
Alloys , Coronary Aneurysm , Prosthesis Design , Ultrasonography, Interventional , Humans , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/surgery , Coronary Aneurysm/therapy , Aged , Female , Treatment Outcome , Self Expandable Metallic Stents , Coronary Angiography , Polytetrafluoroethylene , Percutaneous Coronary Intervention/instrumentation , Stents , Angioplasty, Balloon, Coronary/instrumentationABSTRACT
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.
Subject(s)
Coronary Aneurysm , Coronary Angiography , Tricuspid Valve Insufficiency , Humans , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/complications , Coronary Aneurysm/surgery , Tricuspid Valve Insufficiency/complications , Tricuspid Valve Insufficiency/diagnostic imaging , Tricuspid Valve Insufficiency/etiology , Tricuspid Valve Insufficiency/surgery , Male , Echocardiography, Transesophageal , Middle Aged , FemaleSubject(s)
Coronary Angiography , Fibromuscular Dysplasia , Humans , Fibromuscular Dysplasia/diagnostic imaging , Fibromuscular Dysplasia/complications , Female , Computed Tomography Angiography , Predictive Value of Tests , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/complications , Vascular Diseases/diagnostic imaging , Vascular Diseases/etiology , Vascular Diseases/surgery , Vascular Diseases/congenital , Middle Aged , Treatment Outcome , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/etiology , Coronary Aneurysm/surgeryABSTRACT
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.
Subject(s)
Coronary Aneurysm , Echocardiography , Incidental Findings , Humans , Coronary Aneurysm/surgery , Coronary Aneurysm/diagnostic imaging , Echocardiography/methods , Male , Aortic Dissection/surgery , Aortic Dissection/diagnostic imaging , Aged , Computed Tomography Angiography/methodsSubject(s)
Angioplasty, Balloon, Coronary , Humans , Male , Aortic Dissection/surgery , Aortic Dissection/diagnostic imaging , Aortic Dissection/therapy , Coronary Angiography , Treatment Outcome , Middle Aged , Coronary Vessels/surgery , Coronary Vessels/diagnostic imaging , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/surgery , FemaleABSTRACT
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.
Subject(s)
Coronary Aneurysm , Coronary Angiography , Coronary Artery Bypass , Disease Progression , Immunoglobulin G4-Related Disease , Humans , Male , Coronary Aneurysm/surgery , Coronary Aneurysm/immunology , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/pathology , Middle Aged , Immunoglobulin G4-Related Disease/complications , Immunoglobulin G4-Related Disease/immunology , Immunoglobulin G4-Related Disease/surgery , Immunoglobulin G4-Related Disease/diagnosis , Immunoglobulin G4-Related Disease/pathology , Coronary Vessels/pathology , Coronary Vessels/diagnostic imaging , Coronary Vessels/immunology , Treatment Outcome , Percutaneous Coronary Intervention , Immunoglobulin G/bloodSubject(s)
Aneurysm, False , Heart Ventricles , Iatrogenic Disease , Stents , Humans , Male , Middle Aged , Aneurysm, False/etiology , Aneurysm, False/diagnostic imaging , Aneurysm, False/surgery , Aneurysm, False/therapy , Coronary Aneurysm/etiology , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/surgery , Fistula/etiology , Fistula/surgery , Heart Ventricles/injuries , Stents/adverse effectsABSTRACT
A 77-year-old man presented with an acute inferior ST-segment elevation myocardial infarction.
Subject(s)
Coronary Aneurysm , Coronary Angiography , Electrocardiography , ST Elevation Myocardial Infarction , Humans , Male , Aged , Coronary Aneurysm/diagnosis , Coronary Aneurysm/surgery , Coronary Aneurysm/complications , Coronary Angiography/methods , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/surgery , Coronary Vessels/diagnostic imaging , Percutaneous Coronary Intervention/methods , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Treatment OutcomeABSTRACT
This case report is a step-by-step description of the surgical treatment of a giant right coronary aneurysm with a maximum diameter of 80 mm in a 57-year-old male.