1
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Greiten LE, Laan D, Joyce LD, Greason KL, Daly RC, Schaff HV, King KS, Joyce DL. Management of Coronary Artery Aneurysms at the Time of Surgical Revascularization. J Surg Res 2020; 253:288-293. [PMID: 32402854 DOI: 10.1016/j.jss.2020.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 03/21/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coronary artery aneurysms (CAAs) represent a rare pathology occurring in 1.5%-5% of routine coronary angiograms. Limited data exist on the management of CAA at the time of cardiac surgery. MATERIALS AND METHODS A single-institution retrospective review was performed on 53 patients who underwent cardiac surgery in the setting of atherosclerotic CAA between 1993 and 2015. Patients were stratified based on treatment strategy: exclusion and distal bypass (n = 26) versus revascularization alone (n = 27). Comparisons were made with respect to mortality, need for further/concomitant interventions, and long-term cardiac function including myocardial infarctions and congestive heart failure. RESULTS A total of 53 patients underwent cardiac surgery in the setting of CAA disease. Management strategies included ligation and bypass in 26 patients and distal bypass only in 27 patients (with four of the patients in this group undergoing coronary stenting across the aneurysm). There were no significant differences in patient demographics between the two groups. No significant difference was found in either 30-d (P = 0.74) or long-term mortality when exclusion of the CAA was performed compared with revascularization alone (P = 0.20). More exclusion procedures were performed earlier in the experience (median surgical date 2000), whereas revascularization alone predominated later in the experience (median surgical date 2007; P ≤ 0.001). CONCLUSIONS The practice of CAA exclusion, while still performed in selected cases, has largely been supplanted in patients undergoing revascularization. Exclusion does not appear to offer any advantage over isolated revascularization, supporting the current trends in managing this rare condition.
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Affiliation(s)
- Lawrence E Greiten
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Alaska
| | - Daniel Laan
- Department of General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lyle D Joyce
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Katherine S King
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - David L Joyce
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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2
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Nathani S, Reddy C, Suresh P, Maheshwari S. An unusual case of left main coronary artery aneurysm with right ventricle fistula. Ann Pediatr Cardiol 2012; 5:69-71. [PMID: 22529606 PMCID: PMC3327020 DOI: 10.4103/0974-2069.93715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 4-year-old boy presented with repeated respiratory tract infections. Echocardiography showed dilation of the left main coronary artery with flow into the Right Ventricular Outflow Tract (RVOT). Diagnosis of Left Coronary Artery Aneurysm (LMCA) with RVOT fistula was made. A surgical repair of LMCA aneurysm by two-patch technique was performed. The patient had an excellent outcome postoperatively and is asymptomatic on follow-up.
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Affiliation(s)
- Shweta Nathani
- Department of Pediatric Cardiac Science, Narayana Hrudayalaya, Bangalore, India
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3
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Tamponnade péricardique par rupture d’un anévrisme coronarien. ANNALES FRANCAISES DE MEDECINE D URGENCE 2011. [DOI: 10.1007/s13341-011-0066-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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4
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Erdogan D, Gullu H, Tok D, Muderrisoglu H. An unusual location and causation of coronary artery aneurysm and its surgical treatment—A case report. Int J Angiol 2011. [DOI: 10.1007/s00547-005-1075-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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5
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Mariscalco G, Sessa F, Vanoli D, Mantovani V, Sandro F, Sala A. Transthoracic echocardiography is adequate for the diagnosis of right coronary artery aneurysms. J Card Surg 2008; 23:72-4. [PMID: 18290896 DOI: 10.1111/j.1540-8191.2007.00500.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Coronary artery aneurysms (CAA) are rare but potentially fatal pathologies. This case was referred to our Unit after occasional echocardiographic finding of an intracardiac mass. A new detailed transthoracic echocardiogram was decisive for a diagnosis of a large CAA of the right coronary artery, compressing and dislocating the right atrium. Transesophageal echocardiography was not performed because of the data obtained. The diagnosis was confirmed by cardiac catheterization. The patient was managed with a surgical procedure.
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Affiliation(s)
- Giovanni Mariscalco
- Department of Surgical Sciences, Cardiac Surgery Division, Varese University Hospital, Italy.
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6
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Ying ZQ, Ma J, Xu G, Weng SX, Chen MY. Giant coronary aneurysm fistulous connection to the right ventricle. Intern Med 2008; 47:811-2. [PMID: 18421207 DOI: 10.2169/internalmedicine.47.0889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Zhi-Qiang Ying
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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7
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Meraj PM, Makaryus AN, Boxt LM. An unusual combination of myocardial bridging and coronary artery aneurysm identified on 64-detector coronary angiography. Int J Cardiovasc Imaging 2006; 23:649-53. [PMID: 17043905 DOI: 10.1007/s10554-006-9171-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 09/21/2006] [Indexed: 11/25/2022]
Abstract
Coronary artery aneurysm is an uncommon finding. It is defined as a dilated coronary artery which exceeds the diameter of the normal adjacent vessel by 1.5-2 times. Although theorized mechanisms include atherosclerotic coronary artery disease (CAD) and iatrogenic causes such as the use of percutaneous coronary interventions (PCI), the natural history and prognosis of this disease remain obscure. We describe a case of a 75 year old man who was found to have a long segmental myocardial bridge immediately followed by a 5 mm inner diameter aneurysm in the left anterior descending artery (LAD) detected on 64-detector cardiac computed tomography (64-CT). The post myocardial bridge aneurysmal dilatation in this case is unique, and has not been previously described. With the advent of 64-CT, more incidental cardiac anomalies and irregularities are likely to be found. In the end, the question as to the clinical significance of these findings and their treatment remains controversial. We report this novel case and review the literature for recommendations on treatment and management of patients with coronary aneurysms.
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Affiliation(s)
- Perwaiz M Meraj
- Division of Cardiology, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
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8
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Mariscalco G, Mantovani V, Ferrarese S, Leva C, Orrù A, Sala A. Coronary artery aneurysm: management and association with abdominal aortic aneurysm. Cardiovasc Pathol 2006; 15:100-4. [PMID: 16533698 DOI: 10.1016/j.carpath.2005.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Revised: 10/17/2005] [Accepted: 11/16/2005] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Coronary artery aneurysm (CAA) is a dilatation that exceeds 1.5 times the diameter of a normal adjacent coronary artery. Several studies suggest that pathogenetic mechanisms involved in this disease and in abdominal aortic aneurysm (AAA) are similar. Surgery for CAA is mandatory when the aneurysm is three to four times larger than the original vessel diameter. We reviewed our experience in the surgical treatment of this unusual disease and analyzed its association with AAA. MATERIALS AND METHODS Between October 1993 and March 2005, 11 patients (9 men; mean age=66 years) underwent surgery for CAA. In all cases, coronary aneurysms were diagnosed as incidental findings in coronary angiographies. The coronary aneurysms were isolated and longitudinally incised: the proximal and distal openings were identified and sutured. The sacs were obliterated with running sutures. Myocardial protection was achieved by retrograde cardioplegia only. Coronary artery bypass grafting was performed distally to the excluded aneurysms in all patients. RESULTS One patient died of respiratory failure early after the operations; all other patients are alive, asymptomatic for angina, and free from repeated acute myocardial infarction after a median follow-up of 76 months (range=4-141 months). A total of six patients underwent surgical repair or endoprosthesis implantation because of AAAs. CONCLUSIONS Our operative techniques ensured durable results. We recommend screening for abdominal aneurysms in all affected patients because of the frequent association between CAA and AAA as a result of their similar pathogenetic mechanism.
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Affiliation(s)
- Giovanni Mariscalco
- Department of Surgical Sciences, Cardiac Surgery Division, Varese University Hospital, 21100 Varese, Italy.
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9
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Kereiakes DJ, Long DE, Ivey TD. Coil embolization of a circumflex coronary aneurysm at the time of percutaneous coronary stenting. Catheter Cardiovasc Interv 2006; 67:607-10. [PMID: 16532494 DOI: 10.1002/ccd.20591] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary atherosclerotic aneurysm often occurs in association with severe atherosclerotic coronary stenosis. We describe the percutaneous catheter-based approach to coil embolization of a circumflex coronary aneurysm at the time of obtuse marginal branch coronary stent deployment.
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Affiliation(s)
- Dean J Kereiakes
- The Carl and Edyth Lindner Center for Research and Education, The Lindner Center, Cincinnati, Ohio 45219, USA.
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10
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Tuncer C, Sokmen G, Sokmen A, Guven A. Aneurysm involving bifurcation of left main coronary artery presenting with transient ischemic attack, paroxysmal atrial fibrillation and ventricular tachycardia. Int J Cardiovasc Imaging 2005; 22:317-20. [PMID: 16328854 DOI: 10.1007/s10554-005-9025-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2005] [Accepted: 08/08/2005] [Indexed: 10/25/2022]
Abstract
Coronary artery aneurysm, especially left main coronary artery (LMCA) aneurysm is a rare phenomenon. The disease may be congenital or acquired. The most common cause of coronary artery aneurysm is atherosclerosis. We presented a man with a large LMCA aneurysm presenting with unstable angina, transient ischemic attack, ventricular tachycardia and paroxysmal atrial fibrillation.
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Affiliation(s)
- Cemal Tuncer
- Cardiology Division, Faculty of Medicine, Cardiology Hospital of Hanefi Oksuz, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
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11
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Pinheiro BB, Fagundes WV, Gusmão CA, Lima AMC, Santos LH, Vieira GB. Surgical management of a giant left main coronary artery aneurysm. J Thorac Cardiovasc Surg 2005; 128:751-2. [PMID: 15514604 DOI: 10.1016/j.jtcvs.2004.03.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Bruno B Pinheiro
- Department of Cardiac Surgery, Hospital Santa Genoveva-Clinicord, Av. Concordia 26, 74670-430 Goiania, Brazil.
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12
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Okmen E, Sanli A, Kasikcioglu H, Uyarel H, Cam N. Left main coronary artery aneurysm associated with extensive coronary arterial calcification: case report and review. Int J Cardiovasc Imaging 2004; 20:231-5. [PMID: 15139538 DOI: 10.1023/b:caim.0000021950.28940.7c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We present a 68-year-old male with left main coronary artery aneurysm and extensive coronary calcification involving the entire coronary arterial tree detected by coronary angiography and electron beam computerized tomography. With this article we also discussed the relationships between the pathogenesis of coronary atherosclerosis, coronary calcification, and coronary aneurysm formation.
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Affiliation(s)
- Ertan Okmen
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
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13
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Ercan E, Tengiz I, Yakut N, Gurbuz A. Large atherosclerotic left main coronary aneurysm: a case report and review of literature. Int J Cardiol 2003; 88:95-8. [PMID: 12659991 DOI: 10.1016/s0167-5273(02)00377-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Left main coronary aneurysm is a very rare disorder. Aneurysm may be single or multiple, saccular or fusiform. Atherosclerosis, mucocutaneous lymph node syndrome, trauma, angioplasty, atheroctomy, laser procedures, systemic lupus erythematosus, periarteritis nodosa or types of arteritis, dissection, syphilis, mycotic emboli may lead to coronary aneurysms. The main complications of coronary aneurysms are: thrombosis, distal embolisation, rupture and calcification. Operative therapy should be necessary for large left main coronary aneurysms because of their predisposition to thrombosis and embolism. The coexisting significant obstructive CAD may be important in making a decision for the operative treatment in patients with the left main coronary aneurysm. The proper type of operation is not clear.
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14
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Merchán A, López-Mínguez JR, Alonso F, Fernández De La Concha J, González R, Martínez De La Concha L. [Giant left main coronary aneurysm without associated coronary lesions]. Rev Esp Cardiol 2002; 55:308-11. [PMID: 11893323 DOI: 10.1016/s0300-8932(02)76600-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Left main coronary artery aneurysms are very infrequent (0.1%) and the majority are related to atherosclerotic obstructive lesions. Only a few isolated cases without associated coronary lesions have been reported until now. The management of these patients is not well established, thus both conservative and surgical treatments have been postulated. We present a case of giant left main coronary artery aneurysm with a diameter of 27.7 x 18.6 mm (the biggest reported until now) without coronary tree associated stenosis. It was treated conservatively with oral anticoagulation only and the 5 years evolution has been favourable.
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Affiliation(s)
- Antonio Merchán
- Servicio de Cardiología y Unidad de Cardiología Intervencionista, Hospital Regional Universitario Infanta Cristina, Badajoz, Spain.
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15
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Kereiakes DJ, Broderick TM, Howard WL, Anderson LC, Weber M, Mitts DL. Successful long-term therapy following saphenous vein-covered stent deployment for atherosclerotic coronary aneurysm. Catheter Cardiovasc Interv 2002; 55:100-4. [PMID: 11793504 DOI: 10.1002/ccd.10064] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We describe a case of atherosclerotic aneurysm involving the left main coronary artery in a patient with prior coronary artery bypass surgery. A saphenous vein-covered stent was used to seal the aneurysm in conjunction with conventional stenting of an associated native vessel coronary stenosis. Focal late restenosis involving the stent graft was successfully treated with repeat angioplasty and brachytherapy. Autologous vein-covered stent deployment should be considered in the treatment of symptomatic or progressively enlarging coronary aneurysms.
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Affiliation(s)
- Dean J Kereiakes
- The Lindner Center for Research and Education, Ohio Heart Health Center, Cincinnati, Ohio 45219, USA.
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16
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Pineda GE, Khanal S, Mandawat M, Wilkin J. Large atherosclerotic left main coronary aneurysm--a case report and review of the literature. Angiology 2001; 52:501-4. [PMID: 11515991 DOI: 10.1177/000331970105200710] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Coronary artery aneurysm (CAA) is a rare disorder, characterized by an abnormal dilatation of a localized portion of the coronary artery. It is usually diagnosed incidentally by coronary angiography. Over 50% of coronary artery aneurysms are of atherosclerotic origin. The natural history of coronary aneurysms is not well understood. Their presence is not always considered to be an operative indication; rather, the severity of the associated coronary artery disease (CAD) is what dictates a surgical approach. In the absence of obstructive CAD, the definitive treatment for this condition is unclear. The authors present the case of an isolated saccular left main coronary aneurysm with no associated flow-limiting CAD. The patient was treated medically with antiplatelet and anticoagulant medication with no adverse events at 3, 6, 9, and 12 months of follow-up.
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Affiliation(s)
- G E Pineda
- Cardiovascular Division, Augusta VA Medical Center, Medical College of Georgia, 30912, USA
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17
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Leung AW, Wong P, Wu CW, Tsui PT, Mok NS, Lau ST. Left main coronary artery aneurysm: sealing by stent graft and long-term follow-up. Catheter Cardiovasc Interv 2000; 51:205-9. [PMID: 11025578 DOI: 10.1002/1522-726x(200010)51:2<205::aid-ccd16>3.0.co;2-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe the implantation of a stent graft to seal off the left main coronary artery aneurysm of a 64-year-old man with guidance by intravascular ultrasound. The aneurysm was successfully sealed off. At 6-month and 1-year follow-up, a small residual aneurysm reappeared, which was treated conservatively. The technical issues in closing this aneurysm and the management of the residual aneurysm are discussed.
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Affiliation(s)
- A W Leung
- Cardiology Division, Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China.
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18
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Affiliation(s)
- A S Assiri
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
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19
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Left Main Coronary Artery Disease. Am J Med Sci 1999. [DOI: 10.1016/s0002-9629(15)40665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Cardiology Grand Rounds from The University of Texas Medical Branch. Am J Med Sci 1999. [DOI: 10.1097/00000441-199912000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Rahmatullah SI, Khan IA, Nair VM, Vasavada BC, Sacchi TJ. Bifurcating aneurysm of the left main coronary artery involving left anterior descending and left circumflex arteries--a case report. Angiology 1999; 50:417-20. [PMID: 10348430 DOI: 10.1177/000331979905000508] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Coronary artery aneurysm is a rare coronary abnormality, usually diagnosed incidentally by coronary angiography. Major causes of coronary aneurysms include coronary ectasia, Kawasaki disease, and atherosclerosis. Most of the discrete coronary aneurysms are of atherosclerotic origin. The incidence of atherosclerotic coronary aneurysms is about 0.2%, and the left main coronary artery is the least frequently involved artery. Only a few cases of left main coronary artery aneurysm have been reported in the literature, and a left main coronary artery aneurysm involving the proximal segments of the left anterior descending and the left circumflex arteries has not been reported previously. The authors describe this finding in a man who presented with worsening exertional angina pectoris. Coronary angiography demonstrated an aneurysm of the distal left main coronary artery extending into the proximal segments of the left anterior descending and the left circumflex arteries. In addition, a significant flow-limiting atherosclerotic lesion was present in the proximal portion of the left anterior descending artery distal to the aneurysm.
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Affiliation(s)
- S I Rahmatullah
- Department of Medicine, Long Island College Hospital, Brooklyn, New York, USA
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22
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Abstract
In summary, a patient with multiple coronary aneurysms and operative therapy is described and 17 previously reported similar cases are reviewed. The proper type of operation for this condition is as yet unclear, but, nevertheless, the reported cases and our case with operative therapy have done well postoperatively despite a variety of procedures performed.
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Affiliation(s)
- S Harandi
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA
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23
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Balk AH, Zondervan PE, van der Meer P, van Gelder T, Mochtar B, Simoons ML, Weimar W. Effect of adopting a new histological grading system of acute rejection after heart transplantation. Heart 1997; 78:603-7. [PMID: 9470880 PMCID: PMC1892331 DOI: 10.1136/hrt.78.6.603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment policy of acute rejection after heart transplantation has been changed after adopting the ISHLT endomyocardial biopsy grading system in 1991. OBJECTIVE To determine the effect of this policy change on clinical outcome after transplantation. METHODS The outcome of 147 patients who had a transplant before (early group, median follow up 96 months) and 114 patients who had a transplant after (late group, median follow up 41 months) the introduction of the ISHLT biopsy grading system was studied retrospectively. Initially "moderate rejection" according to Billingham's conventional criteria was treated. From January 1991 grade 3A and higher was considered to require intensification of immunosuppression. RESULTS There were some differences between the two groups: recipients (50 v 44 years) as well as donors (28 v 24 years) were older in the "late group" and more patients of this group received early anti-T cell prophylaxis (92% v 56%). Despite more extensive use of early prophylaxis more rejection episodes were diagnosed (2.4 v 1.4) and considerably more courses of rejection treatment were instituted in the late compared with the early group (3.2 v 1.5). There were no deaths because of rejection in the late group, however, more infections occurred within the first year (mean 1.8 v 1.4) and more non-skin malignancies within the first 41 months were diagnosed (8 of 57 v 6 of 147, 95% CIs of difference includes 0). The incidence of graft vascular disease in the late group has been comparable to the early group until now. CONCLUSION The interpretation of the ISHLT grading system resulted in lowering of the threshold for the diagnosis of rejection thereby increasing the number of rejections and subsequently the immunosuppressive load and its complications.
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Affiliation(s)
- A H Balk
- Department of Pathology, University Hospital, Rotterdam-Dijkzigt, Netherlands
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24
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Abstract
Coronary artery aneurysm is defined as coronary dilatation which exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. This is an uncommon disease which has been diagnosed with increasing frequency since the advent of coronary angiography. The incidence varies from 1.5% to 5% with male dominance and a predilection for the right coronary artery. Atherosclerosis accounts for 50% of coronary aneurysms in adults. Reported complications include thrombosis and distal embolization, rupture and vasospasm. The natural history and prognosis remains obscure. Controversies persist regarding the use of surgical or medical management. The authors recommend surgery based on the severity of associated coronary stenosis rather than the mere presence of aneurysm. Medical therapy is indicated for the majority of patients and consists of antiplatelet and anticoagulant medication.
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Affiliation(s)
- M Syed
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, USA
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25
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Horii T, Suma H. Huge Solitary Aneurysm in Left Main Coronary Artery with Arteriovenous Fistula. Asian Cardiovasc Thorac Ann 1996. [DOI: 10.1177/021849239600400214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 72-year-old female was found to have a huge solitary coronary artery aneurysm in the left main coronary artery, with an associated coronary artery fistula draining into the right atrium through the coronary sinus. She underwent resection and repair of the aneurysm successfully.
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Affiliation(s)
- Taiko Horii
- Department of Cardiovascular Surgery Mitsui Memorial Hospital Tokyo, Japan
| | - Hisayoshi Suma
- Department of Cardiovascular Surgery Mitsui Memorial Hospital Tokyo, Japan
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26
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Tomaru A, Kudou M, Baba J, Goto Y, Miura S, Takikawa K, Yamazaki T, Miho O. Unusual right coronary artery runoff with right and left main coronary artery aneurysm. A case report. Angiology 1996; 47:615-9. [PMID: 8678337 DOI: 10.1177/000331979604700611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A rare case of unusual right coronary artery runoff with right and left main coronary artery aneurysm is presented. The discussion is mainly from the etiologic point of view.
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Affiliation(s)
- A Tomaru
- Department of Internal Medicine-2, Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan
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27
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Abstract
Coronary artery aneurysms are rare, especially in the left main coronary artery. Coronary artery aneurysms may rupture or cause myocardial infarction. There are only a few reports of coronary artery aneurysms of the left main coronary artery treated surgically. We report a case in which an arterial graft from the internal iliac (hypogastric) artery was used for the reconstruction of a congenital coronary artery aneurysm of the left main coronary artery. After a follow-up of 5 years, the patient is well and in good condition.
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Affiliation(s)
- M Lepojärvi
- Department of Cardiothoracic Surgery, Oulu University Hospital, Finland
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28
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Abstract
We report an unusual case involving a 70-year-old man with multiple coronary aneurysms, including a 5-cm aneurysm of the right coronary artery. The precise size was determined with magnetic resonance imaging, although the aneurysms were diagnosed initially on angiography. Multiple coronary aneurysms are rare in adults, The cause may have been atherosclerosis, syphilis, or collagen vascular disease, all of which cause weakening of the media. The patient underwent successful operation, including coronary artery bypass grafting.
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Affiliation(s)
- G S Mohamed
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston 77225, USA
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29
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Abstract
This article reviews and updates the current literature concerning the assessment, diagnosis, and therapy of coronary disease involving the LMCA. Included is recent information regarding the natural history, congenital abnormalities, noninvasive diagnostic studies, and role of coronary bypass surgery and percutaneous coronary interventions in treating disease of the LMCA. At present, it remains that the LMCA is a difficult segment to assess angiographically. The use of noninvasive imaging does not specifically distinguish LMCA from other types of coronary disease. Coronary bypass surgery has a proven benefit in the treatment of disease of the LMCA. Currently, interventional procedures are limited by significant risks, and surgical treatment with coronary bypass surgery remains the therapy of choice.
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Affiliation(s)
- B A Bergelson
- Department of Medicine, Northwestern Memorial Hospital, Chicago, IL 60611
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30
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Fukaya Y, Miyakawa M, Senga O, Hikita H, Kouzu S, Tunemoto H. Surgical management of left main coronary artery aneurysm. Ann Thorac Surg 1994; 57:228-30. [PMID: 8279902 DOI: 10.1016/0003-4975(94)90409-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To date only 7 patients with left main coronary artery aneurysm associated with atherosclerosis have undergone surgical treatment. This report reviews a case of atherosclerotic aneurysm of the left main coronary artery with concurrent stenotic coronary artery disease that was successfully treated by direct approach to the left main coronary artery aneurysm and establishment of coronary artery bypass grafts.
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Affiliation(s)
- Y Fukaya
- Department of Surgery, Shinshu University School of Medicine, Iida, Japan
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31
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La Vecchia L, Bedogni F, Ometto R, Mosele GM, Vincenzi M. Aneurysm of the left main coronary artery without obstructive disease: report of a case presenting with severe unstable angina and treated with systemic thrombolysis. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1993; 30:306-9. [PMID: 8287456 DOI: 10.1002/ccd.1810300409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A fusiform aneurysm of the left main coronary artery without associated obstructive disease was detected in a 77-year-old patient with severe unstable angina treated with systemic thrombolysis. The authors emphasize the following features: (1) unusual location of the aneurysm, (2) absence of concomitant obstruction in this age group, and (3) clinical efficacy of thrombolysis and subsequent long-term oral anticoagulation.
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Affiliation(s)
- L La Vecchia
- Divisione Clinicizzata di Cardiologia, Ospedale Civile S. Bortolo, Vicenza, Italy
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32
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Shalev Y, Vidne B, Snir E, Kracoff OH, Oetinger M, Caspi A. Giant left main pseudoaneurysm obstructing the left anterior descending coronary artery demonstrated by transesophageal echocardiography and coronary angiography. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1993; 30:153-5. [PMID: 8221870 DOI: 10.1002/ccd.1810300214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Left main pseudoaneurysm is a rare angiographic finding in young adults. We describe a 23-year-old male who presented with an acute anterior wall myocardial infarction. Coronary angiography and transesophageal echocardiography reveal a huge aneurysm of the distal left main obstructing the left anterior descending artery (LAD), which was defined by history as a pseudoaneurysm. The pseudoaneurysm was successfully resected and mammary artery was used to repair the distal left main and to bypass the LAD.
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Affiliation(s)
- Y Shalev
- Heart Institute, Kaplan Hospital, Rehovot, Israel
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33
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Stajduhar KC, Laird JR, Rogan KM, Wortham DC. Coronary arterial ectasia: increased prevalence in patients with abdominal aortic aneurysm as compared to occlusive atherosclerotic peripheral vascular disease. Am Heart J 1993; 125:86-92. [PMID: 8417547 DOI: 10.1016/0002-8703(93)90060-m] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Coronary artery ectasia (CAE) is the saccular or fusiform dilatation of a coronary artery. CAE is found in 1.2% to 4.9% of patients at autopsy or during angiographic studies, with a similar prevalence of CAE found in patients with atherosclerotic peripheral vascular disease (PVD). Abdominal aortic aneurysm (AAA) and CAE are similar in pathogenesis and histology. To determine whether CAE occurs more frequently in patients with AAA than in occlusive forms of atherosclerotic PVD, a review of coronary angiograms was performed in patients who underwent cardiac catheterization and vascular reconstruction for AAA or occlusive atherosclerotic PVD of the lower extremities. Of 72 patients with AAA, 15 had CAE (20.8%) compared with only 2 of 69 patients with atherosclerotic PVD (2.9%) (p < 0.003). CAE was predominantly discrete, located in the left coronary system, and associated with significant coronary atherosclerosis. CAE may be more prevalent in patients with AAA resulting from a similar pathogenetic process.
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Affiliation(s)
- K C Stajduhar
- Cardiology Service, Madigan Army Medical Center, Tacoma, Wash
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34
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KRUCOFF MITCHELLW, JACKMAN JOHND, CRATER SUZANNEW, SAWCHAK SHARONT, CURTIS GLORIAJ, PHILLIPS HARRYR. "Over The Shoulder" Guidewire Manipulation Through An Angulated Stenosis Adjacent To A Coronary Aneurysm During High Risk Percutaneous Transluminal Angioplasty. J Interv Cardiol 1992. [DOI: 10.1111/j.1540-8183.1992.tb00837.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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35
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Desai PK, Ro JH, Pucillo A, Weiss MB, Herman MV. Left main coronary artery aneurysm following percutaneous transluminal angioplasty: a report of a case and review of the literature. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1992; 27:113-6. [PMID: 1446329 DOI: 10.1002/ccd.1810270206] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Since its introduction in 1977, the number of PTCAs and its indications have grown. Along with more frequent usage, newer complications have been reported. Aneurysm of left main coronary artery is rare. This report describes the formation of a new non-obstructing aneurysm in the left main coronary artery after PTCA of left circumflex artery. The patient has had 7 yr of follow-up with a benign clinical course.
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Affiliation(s)
- P K Desai
- Cardiac Catheterization Laboratory, New York Medical College, Valhalla 10595
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