1
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Vassilikou A, Xenitopoulou MP, Ziampa K, Evangeliou AP, Mitsiadis S, Syrnioti A, Petrakis G, Tossios P, Vassilikos V, Tzikas S. Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature. BMC Cardiovasc Disord 2024; 24:187. [PMID: 38561678 PMCID: PMC10986014 DOI: 10.1186/s12872-024-03851-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
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.
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Affiliation(s)
- A Vassilikou
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M P Xenitopoulou
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Ziampa
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A P Evangeliou
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Mitsiadis
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Syrnioti
- Pathology Department, "AHEPA" University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Petrakis
- Pathology Department, "AHEPA" University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Tossios
- Cardiothoracic Surgery Department, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Vassilikos
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Tzikas
- 3rd Department of Cardiology, "Hippokration" General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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2
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Nakamura H, Fukuda K, Masue T. Giant right coronary aneurysm with left ventricular fistula. Rev Esp Cardiol (Engl Ed) 2024; 77:353. [PMID: 37802199 DOI: 10.1016/j.rec.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Hiroki Nakamura
- Department of Anesthesiology, Gifu Prefectural General Medical Center, Gifu, Japan.
| | - Kouki Fukuda
- Department of Anesthesiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Tatsuhiko Masue
- Department of Anesthesiology, Gifu Prefectural General Medical Center, Gifu, Japan
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3
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Lai B, Yang Q, Deng M. Coronary artery fistula with giant right coronary artery aneurysm and right coronary sinus tumor. Asian J Surg 2024; 47:1592-1593. [PMID: 38097496 DOI: 10.1016/j.asjsur.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/01/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Banghui Lai
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China; Cardiovascular Remodeling and Dysfunction Key Laboratory of Luzhou, Sichuan province, China.
| | - Qi Yang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China; Cardiovascular Remodeling and Dysfunction Key Laboratory of Luzhou, Sichuan province, China
| | - Mingbin Deng
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China; Cardiovascular Remodeling and Dysfunction Key Laboratory of Luzhou, Sichuan province, China.
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4
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Showkathali R, Yalamanchi RP, Kumar AM, Cs V. Isolated Giant Right Coronary Aneurysm Associated With IgG4-Related Disease. Can J Cardiol 2024; 40:447-449. [PMID: 37806548 DOI: 10.1016/j.cjca.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/23/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Refai Showkathali
- Department of Cardiology and Cardiothoracic Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Radha Priya Yalamanchi
- Department of Cardiology and Cardiothoracic Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India.
| | - Aishwarya Mahesh Kumar
- Department of Cardiology and Cardiothoracic Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Vijayshankar Cs
- Department of Cardiology and Cardiothoracic Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
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5
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Wang C, Zhu W, Chen M, Zheng Y, Fan X. Giant right coronary artery aneurysm with right coronary artery-right atrial fistula. Coron Artery Dis 2024; 35:78-79. [PMID: 37990601 DOI: 10.1097/mca.0000000000001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Chaojie Wang
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Wei Zhu
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Man Chen
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuan Zheng
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Xiaoping Fan
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second affiliated Hospital of Guangzhou University of Chinese Medicine
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6
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Miyaishi K, Miyaguni S, Higa S, Ando M, Maeda T, Kise Y, Furugen T, Inafuku H, Nakaema M, Nagano T, Teruya T, Furukawa K. [Pulmonary Artery Transection in Surgery for Coronary Artery Fistula]. Kyobu Geka 2023; 76:1097-1100. [PMID: 38088074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Coronary artery fistula is a rare abnormality in the communication between a coronary artery and any of the cardiac chambers or major vessels. At present, there is no standard surgical treatment and the most appropriate method is selected on a case-by-case basis. We report one case of coronary artery fistulae in which pulmonary artery transection was required around the left main trunk (LMT). A 62-year-old man who had coronary artery fistulae with an aneurysm which increased from 12 mm to 16 mm in a two-year span. The fistula was located adjacent to the LMT. A complete aneurysm excision under cardiopulmonary bypass was performed, which required pulmonary artery transection. No postoperative complications occurred. Postoperative coronary computed tomography scan showed intact coronary arteries and complete aneurysm removal.
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Affiliation(s)
- Keita Miyaishi
- Department of Thoracic and Cardiovascular Surgery, University of The Ryukyus, Okinawa, Japan
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7
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Tinson AJ, Hafeez B, Abasszade JH. Giant coronary artery aneurysms: a case of progressive dyspnoea. BMJ Case Rep 2023; 16:e257388. [PMID: 37923335 PMCID: PMC10626878 DOI: 10.1136/bcr-2023-257388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Affiliation(s)
- Alistair John Tinson
- General Medicine, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Bilal Hafeez
- General Medicine, The University of Melbourne, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Joshua Haron Abasszade
- General Medicine, Monash Health, Clayton, Victoria, Australia
- General Medicine, Northern Health, Epping, Victoria, Australia
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8
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Arai M, Fujino M, Fujita T, Noguchi T. Left Coronary Artery Aneurysm Causing a Third Mogul. Circ Cardiovasc Imaging 2023; 16:e015441. [PMID: 37847762 DOI: 10.1161/circimaging.123.015441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Marina Arai
- Departments of Cardiovascular Medicine (M.A., M.F., T.N.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masashi Fujino
- Departments of Cardiovascular Medicine (M.A., M.F., T.N.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoyuki Fujita
- Cardiovascular Surgery (T.F.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Teruo Noguchi
- Departments of Cardiovascular Medicine (M.A., M.F., T.N.), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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9
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Zheng H, Fu L, Xu Y, Zhang TF, Che D, Li JQ, Zhou H, Jiang Z, Lin K, Zhang L, Pi L, Gu X. The PTGS1 (rs1330344) CC Genotype Contributes to Susceptibility to Kawasaki Disease in Southern Chinese Children. Angiology 2023; 74:832-839. [PMID: 36056535 DOI: 10.1177/00033197221118343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Kawasaki disease (KD) is an acute systemic vascular disease complicated by coronary artery injury. Although polymorphisms in prostaglandin-endoperoxide synthase 1 (PTGS1) are being increasingly explored in cardiovascular diseases, little is known regarding the connection between PTGS1 polymorphisms and KD risk. We evaluated 834 KD patients and 1474 healthy controls to explore the relationship between PTGS1 polymorphisms (rs1330344 and rs5788) and KD risk. Our results showed that the rs1330344 CC genotype was significantly associated with KD risk and coronary artery injury in children with KD. In combined analysis, individuals with 1-2 unfavorable genotypes had an increased risk of KD, compared with those with no risk genotype. Stratified analysis indicated that the rs1330344 CC genotype is strongly associated with increased risk of KD in children aged ≤60 months and females. Moreover, carrying 1-2 of these SNP genotypes had a higher risk of KD than those who harbored none of them in children ≤60 months of age and females; the risk of coronary artery dilatations/small aneurysms and medium/giant aneurysms was also significantly increased in KD patients. In summary, the PTGS1 rs1330344 CC genotype is associated with increased susceptibility to KD, which may contribute to KD pathogenesis and serve as a genetic biomarker.
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Affiliation(s)
- Hao Zheng
- Department of Clinical Lab, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lanyan Fu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yufen Xu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ting Fang Zhang
- Pharmacy Department, Jiujiang NO.5 People's Hospital, Jiujiang, China
| | - Di Che
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jin Qing Li
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - HuaZhong Zhou
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - ZhiYong Jiang
- Department of Clinical Lab, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Kun Lin
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Li Zhang
- Department of Cardiology, Guangzhou Women and Children's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lei Pi
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoqiong Gu
- Department of Clinical Lab, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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10
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Feng J, Miao Q, Zhang C. Giant coronary aneurysm of Behcet's disease with sudden syncope: a case report. BMC Cardiovasc Disord 2023; 23:463. [PMID: 37715142 PMCID: PMC10503119 DOI: 10.1186/s12872-023-03501-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023] Open
Abstract
Behcet's disease(BD) is a chronic inflammatory vasculitis that rarely affects the arteries, making myocardial infarction unlikely. We report a 28-year-old patient who was admitted to our hospital with multiple sudden syncope. Cardiovascular risk factors such as hypertension (HT), diabetes and obesity were not found in her. Preoperatively, imaging examinations suggested thrombosis of the inferior and superior vena cava and right heart combined with coronary artery aneurysm. The patient was finally diagnosed with a huge coronary artery aneurysm proximal to the left anterior descending artery. Syncope is considered to be caused right ventricular outflow tract obstruction. The patient received a successful aneurysm resection and had an uneventful postoperative recovery.
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Affiliation(s)
- Jingwei Feng
- Research Center of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, PR China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chaoji Zhang
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
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11
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Chen M, Wang J, Ye T, Liu J, Liao S. Successful surgical management of a single coronary artery with giant coronary artery aneurysm with fistula to the right ventricle. Echocardiography 2023; 40:1001-1004. [PMID: 37485614 DOI: 10.1111/echo.15654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023] Open
Abstract
A giant coronary artery aneurysm (GCAA) concurrent with coronary artery fistula is a rare condition, and it becomes even more unusual when combined with a single coronary artery (SCA) anomaly. Here, we report such an extremely rare case, who is a 35-year-old woman presenting with severe chest distress. A GCAA with fistula to the right ventricle was noted, occurring in a single coronary artery, diagnosed by multimodality cardiovascular imaging techniques. Both GCAA and coronary artery fistula can cause severe cardiac complications, which jeopardize life. While an SCA is mostly asymptomatic, it may also lead to sudden cardiac death as well. Therefore, surgical intervention was recommended. We chose a novel thrombus-inducing strategy to eliminate the GCAA and repair the fistula. Symptoms were relieved after the surgery, and the patient remained asymptomatic over 8 months of follow-up.
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Affiliation(s)
- Mei Chen
- Department of Ultrasonography, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Jue Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Teng Ye
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinjin Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shusheng Liao
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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12
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Ali S, Khan M, Farooq F, Changezi H. Giant right coronary artery aneurysm in a dominant right system. BMJ Case Rep 2023; 16:e253980. [PMID: 37558275 PMCID: PMC10414112 DOI: 10.1136/bcr-2022-253980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
Giant coronary artery aneurysms (GCAAs) are unusual and extremely rare. Due to their rarity, there is a lack of data on managing GCAAs. A man in his 70s who presented with worsening shortness of breath and bilateral lower extremity oedema was found to have non-ST elevation myocardial infarction. Coronary angiography showed a tortuous Shepherd's crook right coronary artery with ectasia and a gigantic 4.5×4 cm saccular aneurysm in the mid-right coronary artery with limited flow to the distal vasculature. He subsequently underwent aneurysmal clipping and excision with coronary artery bypass grafting. GCAAs are usually silent and diagnosed incidentally but can also present with variable cardiac symptoms. Treatment options include medical management, percutaneous coronary angioplasty and surgery. As per limited available literature, surgical resection has shown favourable outcomes, especially in symptomatic GCAAs. The patient reported significant symptomatic improvement on the follow-up office visit.
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Affiliation(s)
- Shafaqat Ali
- Department of Medicine, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Mahin Khan
- Department of Cardiology, The Mount Sinai Hospital, New York City, New York, USA
| | - Faryal Farooq
- Department of Medicine, Allama Iqbal Medical College, Lahore, Punjab, Pakistan
| | - Hameem Changezi
- Department of Cardiology, McLaren Health Care Corp, Flint, Michigan, USA
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13
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Jung JH, Hwang S, Jung JY, Park JW, Lee EJ, Lee HN, Kim JH, Kim DK, Kwak YH. Brain natriuretic peptide as a clinical screening tool for the diagnosis of Kawasaki disease. Medicine (Baltimore) 2023; 102:e34319. [PMID: 37478221 PMCID: PMC10662796 DOI: 10.1097/md.0000000000034319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/22/2023] [Indexed: 07/23/2023] Open
Abstract
N-terminal pro-brain natriuretic peptide (NT-proBNP) has been studied as a diagnostic screening tool for Kawasaki disease (KD). However, brain natriuretic peptide (BNP) has been less studied while has less variability among age groups. We aimed to find out if BNP can be used as a diagnostic screening tool for KD in Korea. This was a retrospective cohort study performed in a single pediatric emergency department. Patients younger than 19 years of age who presented with fever and underwent BNP examination for suspected KD was included. The primary outcome was the diagnostic performance of BNP for KD, and the secondary outcome was the diagnostic performance of BNP for coronary artery aneurysm (CAA). We also derived a scoring system for predicting KD and CAA. Of the 778 patients who were finally included, 400 were not diagnosed with KD and 378 were diagnosed with KD. The odds ratio of BNP at the cutoff of 30 pg/mL for KD was 7.80 (95% CI, 5.67-10.73) in the univariate analysis and 3.62 (95% CI, 2.33-5.88) in the multivariable analysis. The odds ratio of BNP at the cutoff of 270 pg/mL for CAA was 3.67 (95% CI, 2.18-6.19) in the univariate analysis and 2.37 (95% CI, 1.16-8.74) in the multivariable analysis. The AUC of KD and CAA were 0.884 and 0.726, respectively, which was the highest AUCs among all variables. Additionally, we proposed a scoring system for KD and CAA. It is important to clinically suspect KD and CAA in children with high BNP levels.
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Affiliation(s)
- Jae Ho Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soyun Hwang
- Department of Pediatrics, Severance Children’s Hospital, Seoul, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eui Jun Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Hee Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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14
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Tang M, Zhang Z, Wang L, Qian H, Wu W, Liu Z, Shen Z, Chen H, Guo Z, Tian R, Zhang S. Coronary artery ectasia associated with IgG4-related disease: a case report and literature review. BMC Cardiovasc Disord 2023; 23:347. [PMID: 37438699 PMCID: PMC10339667 DOI: 10.1186/s12872-023-03369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Coronary artery ectasia is defined as a local or diffuse dilatation of the coronary artery more than 1.5 times the diameter of the adjacent normal segment. The etiology of coronary artery ectasia is diverse, and rarely complicated with immunoglobulin G4-related disease (IgG4-related disease). A limited number of cases have been reported, with insidious onset, slow progression but poor prognosis. CASE PRESENTATION we report a patient with coronary artery ectasia combined with IgG4-related disease. He has been diagnosed with IgG4-related disease 5 years after his first percutaneous coronary intervention (PCI). Despite routine treatment with steroids, he develops a large coronary aneurysm and eventually died. CONCLUSIONS It is suggested that a thorough evaluation should be performed when coronary artery ectasia is diagnosed. The factors such as manifestations of coronary artery thickening, typical imaging features, other aortas involvement, increased serum IgG4 level, etc. should be considered for early diagnosis of key etiologies.
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Affiliation(s)
- Muyun Tang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Zhiyu Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Liang Wang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Hao Qian
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Wei Wu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Zhenyu Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Zhujun Shen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Hua Chen
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Zhiwei Guo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ran Tian
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
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15
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Pujara J, Panda S, Singh G, Harbola G, Sachan P, Chhauda T, Vachaparampil R. Left main coronary artery aneurysm with fistula to superior vena cava: A challenging case. Ann Card Anaesth 2023; 26:215-218. [PMID: 37706391 PMCID: PMC10284485 DOI: 10.4103/aca.aca_326_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/20/2021] [Accepted: 06/05/2021] [Indexed: 09/15/2023] Open
Abstract
Coronary artery fistulas (CAFs) are rare congenital coronary artery abnormalities, with direct communication between a coronary artery and a cardiac chamber, great vessel or other structure. We report here, a rare case of a 25-year-old male with CAF from the aneurysmal left main coronary artery to the superior vena cava detected on echocardiography and computerized tomography (CT) coronary angiography.
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Affiliation(s)
- Jigisha Pujara
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Suvendu Panda
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Guriqbal Singh
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Garima Harbola
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Pragya Sachan
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Tanya Chhauda
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Ryan Vachaparampil
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
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16
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Kang N, Choi KH, Kim SM, Kim DK, Sung K, Choi DC. Giant Coronary Artery Aneurysm with Thrombosis Complicated in a Patient with Idiopathic Hypereosinophilic Syndrome. Yonsei Med J 2023; 64:148-151. [PMID: 36719023 PMCID: PMC9892543 DOI: 10.3349/ymj.2022.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 01/17/2023] Open
Abstract
Idiopathic hypereosinophilic syndrome (iHES) is a rare systemic disease that is characterized by persistent peripheral eosinophilia (absolute eosinophil count ≥1500/uL) for more than 6 months, with end-organ damage and absence of a primary cause for eosinophilia. Coronary artery aneurysm (CAA) is a rare but life-threatening complication. Here, we report a case of CAA with thrombosis in a patient with iHES in whom the disease activity was well-controlled (eosinophil count <500/uL) for several years. Despite modest control of the disease activity, giant CAA can be associated with iHES; and therefore, close surveillance and monitoring for the development of complications is warranted.
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Affiliation(s)
- Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mok Kim
- Department of Radiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk-Kyung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Chull Choi
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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17
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Giryes S, McGonagle D. Immune and non-immune mechanisms that determine vasculitis and coronary artery aneurysm topography in Kawasaki disease and MIS-C. Clin Exp Rheumatol 2023; 22:103240. [PMID: 36496111 DOI: 10.1016/j.autrev.2022.103240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
The overlap between multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) including coronary artery aneurysms (CAA) and broadly shared gastrointestinal and mucocutaneous disease is poorly defined. In this perspective, we highlight common age-related extravascular epicardial microanatomical and immunological factors that might culminate in CAA expression in both MIS-C and KD. Specifically, the coronary vasa vasorum originates outside the major coronary arteries. Widespread inflammation in the epicardial interstitial compartment in shared between KD and MIS-C. Age-related changes in the neonatal and immature coronary vasculature including the impact of coronary artery biomechanical factors including coronary vessel calibre, age-related vessel distensibility, flow, and vessel neurovascular innervation may explain the decreasing CAA frequency from neonates to older children and the virtual absence of CAA in young adults with the MIS-C phenotype. Other KD and MIS-C features including mucocutaneous disease with keratinocyte-related immunopathology corroborate that disease phenotypes are centrally influenced by inflammation originating outside vessel walls but a potential role for primary coronary artery vascular wall inflammation cannot be excluded. Hence, common extravascular originating tissue-specific responses to aetiologically diverse triggers including superantigens may lead to widespread interstitial tissue inflammation characteristically manifesting as CAA development, especially in younger subjects. Given that CAA is virtually absent in adults, further studies are needed to ascertain whether epicardial interstitial inflammation may impact on both coronary artery physiology and cardiac conduction tissue and contribute to cardiovascular disease- a hitherto unappreciated consideration.
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Affiliation(s)
- Sami Giryes
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, United Kingdom.
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18
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Latif A, Tran A, Ahsan J, Lateef N, Abusina W, Kapoor V, Ahsan Z, Ahmad S, Mirza M. Coronary Artery Aneurysms as a Cause of Acute Coronary Syndrome Presentation - A Focused Review. Curr Cardiol Rev 2023; 19:68-72. [PMID: 36999696 PMCID: PMC10518882 DOI: 10.2174/1573403x19666230331103508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 04/01/2023] Open
Abstract
Coronary artery aneurysms (CAA) are defined as a dilation of a coronary vessel greater than 1.5 times the diameter of a local reference vessel. While CAAs tend to be incidental findings on imaging, they result in complications, such as thrombosis, embolization, ischemia, arrhythmias, and heart failure. Among symptomatic cases, chest pain has been the most common manifestation of CAAs. This necessitates an understanding of CAAs as a cause of acute coronary syndrome (ACS) presentation. However, due to the unclear pathophysiology of CAAs and their variable presentation complicated by similar ACS conditions, there is no clear strategy for CAA management. In this article, we will discuss the contribution of CAAs to ACS presentations and review the current management options for CAAs.
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Affiliation(s)
- Azka Latif
- Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Amy Tran
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Junaid Ahsan
- Division of Cardiovascular Medicine, Mercy Medical Center, Iowa Heart Center, Des Moines, Iowa, USA
| | - Noman Lateef
- Division of Cardiovascular Medicine, University of Nebraska Medicine, Omaha, Nebraska, USA
| | - Waiel Abusina
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
| | - Vikas Kapoor
- Department of Medicine, CHI Health Good Samaritan Hospital, Kearney, Nebraska, USA
| | - Zoraiz Ahsan
- Department of Medicine, Pakistan Medical Center, Islamabad, Pakistan
| | - Soban Ahmad
- Department of Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina, USA
| | - Mohsin Mirza
- Department of Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
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19
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Liu J, Ye B, Su D, Qin S, Zhao W, Pang Y. Evaluation of laboratory predictors for intravenous immunoglobulin resistance and coronary artery aneurysm in Kawasaki Disease before and after therapy. Clin Rheumatol 2023; 42:167-177. [PMID: 36129563 PMCID: PMC9491265 DOI: 10.1007/s10067-022-06366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/28/2022] [Accepted: 09/04/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We aimed to evaluate the clinical and laboratory characteristics of patients with Kawasaki disease (KD) before and after therapy. METHODS Patients with KD were divided into different groups according to their responsiveness to initial intravenous immunoglobulin (IVIG) treatment and coronary status. The clinical and laboratory parameters before and after therapy were compared. Multivariate analysis was performed to identify the independent risk factors, and the receiver operating characteristic (ROC) curve was applied to assess and compare the prediction ability of risk factors and their fluctuations. RESULTS Of the 153 patients included in the study, 41 (26.8%) had IVIG resistance and 37 (24.2%) had developed CAA. After stratifying by therapy response, the two groups differed in the levels of total bilirubin (TSB), albumin, and sodium, neutrophil-to-lymphocyte count ratio (NLR), platelet-to-lymphocyte count ratio (PLR), TSB-to-albumin (B/A) ratio, and prognostic nutritional index (PNI) before IVIG, and in the white blood cell count (WBC), neutrophil count, levels of hemoglobin, C-reactive protein (CRP), alanine aminotransferase (ALT), and albumin, NLR, PNI, capillary leakage index (CLI), and systemic immune-inflammation index (SII) after IVIG. Multivariate analysis revealed that the B/A ratio before IVIG and CLI and SII after IVIG were significantly and positively associated with IVIG resistance and that there was a larger decline in the B/A ratio and smaller decline in CLI and SII pre- and post-treatment in the IVIG-resistant group than in the IVIG-responsive group. However, no statistical differences in the fluctuations of the B/A ratio, CLI, and SII as well as all parameters before and after therapy were observed in patients with and without CAA. ROC curve analyses found a greater AUC value of post-treatment parameters (0.751 and 0.706 for CLI and SII, respectively) compared with pre-treatment parameters (0.654 for B/A ratio) in predicting IVIG resistance; however, the predictive ability of the fluctuations in risk factors before and after therapy was not superior to that of baseline values. CONCLUSIONS The B/A ratio before IVIG and CLI and SII after IVIG were risk factors for IVIG resistance in patients with KD, independent of CAA development. Key Points • A high total bilirubin-to-albumin ratio before IVIG and high capillary leakage and systemic immune-inflammation indices after IVIG may indicate an increased risk of intravenous immunoglobulin resistance in patients with Kawasaki disease. • Post-treatment parameters were superior to pre-treatment parameters in terms of prediction; therefore, rapid and repeated assessment of risk factors before and after treatment must be considered in children in whom the vital signs and symptoms do not improve after treatment.
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Affiliation(s)
- Jie Liu
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
| | - Bingbing Ye
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
| | - Danyan Su
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
| | - Suyuan Qin
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
| | - Weiying Zhao
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
| | - Yusheng Pang
- Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, No 6, Shuangyong Road, Nanning, Guangxi Zhuang Autonomous Region 530000 China
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20
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Onoki T, Metoki T, Iwasawa S, Kawano K, Kimura M, Kure S, Ota C. Two Distinct Cases of Adult-onset Kawasaki Disease. Intern Med 2022; 61:3525-3529. [PMID: 35466164 PMCID: PMC9790799 DOI: 10.2169/internalmedicine.9044-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Kawasaki disease (KD) is a systemic vasculitis syndrome that mostly affects children under 4 years old. Among the reported KD cases, only 1% were over 10 years old. We herein report 2 cases of adult-onset KD (AKD) in 19- and 17-year-old boys diagnosed with a persistent fever and cervical lymphadenitis. Both patients showed cardiac complications, such as coronary artery dilation and myocarditis. Repeated intravenous immunoglobulin therapy was effective in the 19-year-old, while plasma exchange therapy was needed for the 17-year-old, with no sequelae noted at discharge. KD should be considered as a differential diagnosis for persistent fever in adults.
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Affiliation(s)
- Takehiko Onoki
- Department of Pediatrics, Tohoku University Hospital, Japan
| | - Takaya Metoki
- Department of Pediatrics, Yamagata Prefectural Central Hospital, Japan
| | - Shinya Iwasawa
- Department of Pediatrics, Tohoku University Hospital, Japan
| | - Kengo Kawano
- Department of Pediatrics, Yamagata Prefectural Central Hospital, Japan
| | - Masato Kimura
- Department of Cardiology, Miyagi Children's Hospital, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University Hospital, Japan
| | - Chiharu Ota
- Department of Pediatrics, Tohoku University Hospital, Japan
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21
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Koyama K, Miyazu K, Ikeda M. [Giant Right Coronary Artery Pseudoaneurysm:Report of a Case]. Kyobu Geka 2022; 75:1018-1022. [PMID: 36299156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Giant coronary artery aneurysm is very rare and there is no clear consensus regarding its treatment. Herein, we report a case of this unusual entity. The patient was a 75-year-old man in whom follow-up coronary angiography showed leakage of contrast agent from one of the #4 posterior descending( #4PD) branch of the right coronary artery. Enhanced computed tomography (eCT) revealed a giant pseudoaneurysm with a maximum diameter of 55 mm. Percutaneous balloon angioplasty had been performed in the same vessel for angina pectoris 20 years earlier. We excluded the pseudoaneurysm from arterial perfusion by closing both the wall defect and the culprit branch under cardiopulmonary bypass. There was no need for revascularization because there was another #4PD branch nearby. No adverse events were observed after surgery. Postoperative eCT scans confirmed that the aneurysm was completely thrombosed with no leakage.
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Affiliation(s)
- Kazunori Koyama
- Department of Cardiovascular and Thoracic Surgery, Toyama Red Cross Hospital, Toyama, Japan
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22
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Rubini-Costa R, Sola-García E, Alcalá-López JE. Coronary-pulmonary fistula with focal aneurysm of the diagonal artery. Revista Española de Cardiología (English Edition) 2022; 76:389. [PMID: 36379364 DOI: 10.1016/j.rec.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/16/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Ricardo Rubini-Costa
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - Elena Sola-García
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Juan E Alcalá-López
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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23
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Djohan AH, Sia CH, Chan KH, Chai P, Tan HC. Giant right coronary artery aneurysm in a patient presenting with ST-segment elevation myocardial infarction. Coron Artery Dis 2022; 33:508-509. [PMID: 34919058 DOI: 10.1097/mca.0000000000001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Koo Hui Chan
- Department of Cardiology, National University Heart Centre
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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24
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Asadbeygi A, Lee S, Kovalchin J, Hatoum H. Predicting hemodynamic indices in coronary artery aneurysms using response surface method: An application in Kawasaki disease. Comput Methods Programs Biomed 2022; 224:107007. [PMID: 35834899 DOI: 10.1016/j.cmpb.2022.107007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/22/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Coronary artery aneurysms (CAA), such as those in Kawasaki Disease (KD), induce hemodynamic alterations associated with thrombosis and atherosclerosis. Current clinical routines assess the risk level of the CAA cases based on the Z-Score, which considers the body surface area (BSA) and the CAA's diameter. A full geometric characterization and impact on hemodynamic metrics and their correlation with thrombotic risks have not been systematically investigated. The goal of this study was to investigate the effect of CAA shape indices on local hemodynamics using the response surface method (RSM) through considering KD applications. METHODS Transient computational fluid dynamics (CFD) simulations have been performed on idealized CAA geometries defined by geometrical ratios combining neck diameter, CAA diameter and CAA length. The results were used to develop full quadratic regression models of the indices using the response surface method (RSM). Validation using patient-specific KD models was performed. RESULTS The results indicated that the aneurysm diameter is the main determining factor in the thrombotic risk of CAA patients, which is consistent with clinical guidelines. Furthermore, it was observed that in most CAA cases having the same diameter, the one with the shorter length experiences higher RRT values, indicating flow stagnation and circulation. CONCLUSIONS The developed regression models can be used to ultimately assess the thrombotic risk of CAA cases from the hemodynamic perspective. The applicability of these models was tested on 2 KD patient specific models, with close values achieved between the models and the patient-specific results.
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Affiliation(s)
- Alireza Asadbeygi
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, United States
| | - Simon Lee
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States
| | - John Kovalchin
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, United States; Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, 1400 Townsend Dr, Houghton, MI 49931, United States.
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25
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Eyuboglu M, Eyuboglu C. Coronary Artery Ectasia in the Pathophysiology of Myocardial Infarction With Nonobstructive Coronary Arteries. Am J Cardiol 2022; 171:28-31. [PMID: 35287947 DOI: 10.1016/j.amjcard.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/01/2022] [Accepted: 01/17/2022] [Indexed: 11/16/2022]
Abstract
Coronary artery ectasia (CAE) is associated with an increased risk for acute myocardial infarction (AMI). A significant proportion of patients with AMI have no obstructive coronary artery disease (CAD), however, the underlying mechanism of myocardial infarction with nonobstructive coronary arteries (MINOCA) is poorly understood. Therefore, the present study aimed to investigate whether CAE has a role in the pathogenesis of MINOCA. A total of 1,284 patients who were admitted with a diagnosis of non-ST-segment elevation myocardial infarction were included in the study. Patients were divided into 2 groups according to the presence or absence of obstructive CAD (≥50% stenosis). Patients without obstructive CAD (MINOCA group) and patients with obstructive CAD (no-MINOCA group) were compared regarding the frequency of CAE. Additionally, the association between CAE and MINOCA was investigated. In the study participants, 101 patients (7.9%) were diagnosed with MINOCA, whereas 1,183 (92.1%) had AMI with obstructive CAD. Importantly, the frequency of patients with CAE was significantly higher in patients with MINOCA compared with those with obstructive CAD (22.8% vs 3.5%, p <0.001). Moreover, CAE was observed in 64 patients (4.9%). The frequency of MINOCA was found to be significantly higher in patients with CAE compared with patients without CAE (35.9% vs 6.4%, p <0.001). Furthermore, multivariate analysis demonstrated that the presence of CAE was an independent predictor of MINOCA in patients presented with a diagnosis of non-ST-segment elevation myocardial infarction (odds ratio 1.812, 95% confidence interval 1.376 to 2.581, p <0.001). In conclusion, CAE may be considered as a risk factor for MINOCA and may have a role in the pathophysiology of MINOCA.
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Affiliation(s)
| | - Canan Eyuboglu
- Department of Anatomy, Gaziosmanpasa University School of Medicine, Tokat, Turkey
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26
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Muscoli S, Lecis D, Prandi FR, Ylli D, Chiocchi M, Cammalleri V, Lauro D, Andreadi A. Risk of sudden cardiac death in a case of spontaneous coronary artery dissection presenting with thyroid storm. Eur Rev Med Pharmacol Sci 2022; 26:3712-3717. [PMID: 35647853 DOI: 10.26355/eurrev_202205_28867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Spontaneous coronary artery dissection (SCAD) is a spontaneous separation of the coronary artery wall whose etiology appears to be poorly understood. SCAD is a rare cause of acute coronary syndromes, and it is a life-threatening condition. CASE REPORT We report the case of a young woman who developed SCAD during a thyroid storm (TS). RESULTS To the best of our knowledge, this is the first reported case of SCAD during a TS, and it suggests a possible association between high levels of circulating thyroid hormones and SCAD susceptibility. CONCLUSIONS Early identification of SCAD predisposing factors is important to identify high-risk patients. In patients presenting to the emergency department because of chest pain with a history of dysthyroidism, early determination of thyroid hormones and troponin could prevent certain forms of sudden cardiac death.
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Affiliation(s)
- S Muscoli
- Division of Cardiology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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27
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Santimahakullert K, Vijarnsorn C, Wongswadiwat Y, Chanthong P, Khrongsrattha S, Panamonta M, Chan-on P, Durongpisitkul K, Chungsomprasong P, Kanjanauthai S, Soongswang J. A retrospective cohort study of major adverse cardiac events in children affected by Kawasaki disease with coronary artery aneurysms in Thailand. PLoS One 2022; 17:e0263060. [PMID: 35085339 PMCID: PMC8794099 DOI: 10.1371/journal.pone.0263060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/12/2022] [Indexed: 11/18/2022] Open
Abstract
Kawasaki disease (KD) is a common form of vasculitis in children that can be complicated by coronary artery aneurysms (CAAs). Data of long-term outcomes and major adverse cardiac events (MACE) in children with CAAs following KD in developing country are limited. Our aims were to determine the rates of MACE and identify risk factors associated with MACE in children with KD and CAAs in Thailand. We performed a retrospective analysis of data from 170 children diagnosed with KD and CAAs in two tertiary hospitals between 1994 and 2019. During a median (range) follow-up of 5.4 years (22 days to 23 years), 19 patients (11.2%) experienced MACE, that included 12 coronary artery bypass grafting, 2 percutaneous coronary intervention and 5 children with evidence of myocardial ischemia and coronary occlusion. Coronary interventions were performed at a median time of 4 years (0.01 to 9.5 years) after KD diagnosis. Forty-nine patients (28.8%) had giant CAAs. No MACE was reported in children with small CAAs. Independent risks of MACE were from the absence of intravenous immunoglobulin treatment (HR 7.22; 95% CI 2.21 to 23.59; p = 0.001), the presence of giant aneurysms (HR 13.59; 95% CI 2.43 to 76.09; p = 0.003), and CAAs that involved bilateral branches of coronary arteries (HR 6.19; 95% CI 1.24 to 30.92; p = 0.026). Among children with giant CAAs, the intervention-free rate was 93.8%, 78.7% and 52.2%, at 1, 5 and 10 years, respectively. Of note, 81% of the small CAAs regressed to a normal size, and for medium CAAs, 50% regressed to normal size. Overall, ~10% of children with CAAs following KD experienced MACE in this cohort. Timely IVIG treatment in children with KD following symptom onset will reduce the risk of MACE. Cautious surveillance to identify cardiac complications should be recommended for children once medium or giant CAAs develop. Trial registration:TCTR20190125004.
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Affiliation(s)
- Kanokvalee Santimahakullert
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chodchanok Vijarnsorn
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Yuttapong Wongswadiwat
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Prakul Chanthong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sappaya Khrongsrattha
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manat Panamonta
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Paradorn Chan-on
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Kritvikrom Durongpisitkul
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Paweena Chungsomprasong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supaluck Kanjanauthai
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jarupim Soongswang
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Peña-Juárez A, Medina-Andrade MA, Olivares IER, Colín-Ortíz JL, Yamazaki-Nakashimada MA, Garrido-Garcia LM. Multiresistant Kawasaki Disease Complicated With Facial Nerve Palsy, Bilateral Giant Coronary Artery Aneurysms, and Stenosis of the Right Coronary Artery in an Infant. J Clin Rheumatol 2021; 27:S351-S354. [PMID: 33298814 DOI: 10.1097/rhu.0000000000001586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Greif S, Bernas M, Cogan J, Ghani OA. Case of Mycotic Coronary Aneurysm Treated with Percutaneous Coil Embolization. Hawaii J Health Soc Welf 2021; 80:291-294. [PMID: 34877540 PMCID: PMC8646862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mycotic coronary aneurysms are rare, with potentially fatal complications. The treatment of choice is surgical intervention. We present a case of a mycotic coronary aneurysm secondary to a catheter-related bloodstream infection, failed surgical treatment, and eventual treatment with percutaneous coil embolization.
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Affiliation(s)
- Shana Greif
- Cardiovascular Disease Fellowship Program, John A. Burns School of Medicine, University of Hawai‘i (SG)
| | - Monika Bernas
- Internal Medicine Residency Program, John A. Burns School of Medicine, University of Hawai‘i (MB)
| | - John Cogan
- Interventional Cardiology, The Queen’s Medical Center, Honolulu, HI (JC)
| | - Omar Abdul Ghani
- Cardiovascular Disease, The Queen’s Medical Center, Honolulu, HI (AG)
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30
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Herrera A, Matute Martinez CF, Toledo Martinez JF, Beall A. Management of a large intraluminal thrombus in an aneurysmal coronary segment with normal coronary flow. BMJ Case Rep 2021; 14:e245219. [PMID: 34848409 PMCID: PMC8634238 DOI: 10.1136/bcr-2021-245219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/04/2022] Open
Abstract
A coronary artery aneurysm (CAA) is an uncommon clinical finding with an incidence of <5% in adults. The presence of a large intracoronary thrombus within an aneurysmal coronary artery and normal coronary flow is usually a very challenging case scenario. Here, we present a case of a patient presenting with typical chest pain symptoms, high-risk findings on a pharmacological nuclear stress test and coronary angiogram showing severe multivessel coronary artery disease, including a large aneurysmal segment within the proximal left anterior descending artery with a large thrombus that did not affect intracoronary flow. Today, there are no published guidelines for the management of CAA with a normal intracoronary flow. The approach used in this case was initial antithrombotic therapy followed by a successful staged percutaneous coronary intervention. Here, we present a case supporting the use of combined intravenous anticoagulant and antiplatelet therapy for 48 hours, followed by successful percutaneous intervention guided by intravascular ultrasound.
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Affiliation(s)
- Alejandro Herrera
- Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Odessa, Texas, USA
| | | | - Juan Fernando Toledo Martinez
- Universidad Católica de Honduras Nuestra Señora Reina de la Paz, Facultad de medicina y cirugia, San Pedro Sula, Honduras
| | - Allan Beall
- Interventional Cardiology Department, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
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31
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Sakurada T, Uchiyama H, Maeda T, Muraki S, Nakashima S, Araki E. [Coronary Aneurysm with Fistula]. Kyobu Geka 2021; 74:987-991. [PMID: 34795139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We successfully treated two rare cases of coronary aneurysm with fistula. Case 1;A 65-year-old female referred to our hospital with the coronary aneurysm and fistula. Right coronary aneurysm with fistula leading to coronary sinus was observed. Coronary bypass surgery using a saphenous vein to #4PD was performed, and two right ventricle branches were reconstructed. Coronary aneurysm was resected. Case 2;A 46-year-old male was admitted with chest discomfort. Coronary aneurysm with fistula from the left main trunk to left ventricle was demonstrated. Ligation of the coronary artery aneurysm and suture closure of the entry site to the left ventricle was performed. Both patients had uneventful recovery.
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Affiliation(s)
- Taku Sakurada
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Japan
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32
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Chahal N, Rush J, Manlhiot C, Delayun C, Sananes R, Runeckles K, Collins T, O'Shea S, McCrindle BW. Understanding the Educational Support and Psychosocial Needs of Parents and Adolescents With Kawasaki's Disease and Coronary Artery Aneurysms. J Pediatr Health Care 2021; 35:e21-e31. [PMID: 34238625 DOI: 10.1016/j.pedhc.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Kawasaki disease (KD) with coronary artery aneurysms (complex KD) presents relentless challenges for families. Psychosocial experiences and needs were explored. METHOD A descriptive, exploratory study of adolescents and parents using a needs survey and psychosocial instruments (anxiety, depression, and functional impairment). RESULTS Fifty-one parents and 38 adolescents participated. Predominant interests were for information sheets, newsletters, Web sites, and phone applications. Gaps in disease-specific knowledge and awareness of coronary artery aneurysms between parents and adolescents were identified. Psychosocial concerns for adolescents included symptoms of anxiety (22%), depression (13%), and functional impairment (22%). Multivariable analyses indicated higher depression scores associated with longer travel distance from specialists (p = .04). Parent-reported social concerns for their adolescent were associated with higher anxiety (p = .005) and functional impairment (p = .005). Written commentary complemented the findings. DISCUSSION Care protocols require psychosocial assessment/referral and the use of virtual platforms. The groundwork was laid for developing patient and family-centered strategies.
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33
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Wang X, Montero-Cabezas JM, Mandurino-Mirizzi A, Hirasawa K, Ajmone Marsan N, Knuuti J, Bax JJ, Delgado V. Prevalence and Long-term Outcomes of Patients with Coronary Artery Ectasia Presenting with Acute Myocardial Infarction. Am J Cardiol 2021; 156:9-15. [PMID: 34344511 DOI: 10.1016/j.amjcard.2021.06.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/11/2022]
Abstract
Coronary artery ectasia (CAE) is described in 5% of patients undergoing coronary angiography. Previous studies have shown controversial results regarding the prognostic impact of CAE. The prevalence and prognostic value of CAE in patients with acute myocardial infarction (AMI) remain unknown. In 4788 patients presenting with AMI referred for coronary angiography the presence of CAE (defined as dilation of a coronary segment with a diameter ≥1.5 times of the adjacent normal segment) was confirmed in 174 (3.6%) patients (age 62 ± 12 years; 81% male), and was present in the culprit vessel in 79.9%. Multivessel CAE was frequent (67%). CAE patients were more frequently male, had high thrombus burden and were treated more often with thrombectomy and less often was stent implantation. Markis I was the most frequent angiographic phenotype (43%). During a median follow-up of 4 years (1-7), 1243 patients (26%) experienced a major adverse cardiovascular event (MACE): 282 (6%) died from a cardiac cause, 358 (8%) had a myocardial infarction, 945 (20%) underwent coronary revascularization and 58 (1%) presented with a stroke. Patients with CAE showed higher rates of MACE as compared to those without CAE (36.8% versus 25.6%; p <0.001). On multivariable analysis, CAE was associated with MACE (HR 1.597; 95% CI 1.238-2.060; p <0.001) after adjusting for risk factors, type of AMI and number of narrowed coronary arteries. In conclusion, the prevalence of CAE in patients presenting with AMI is relatively low but was independently associated with an increased risk of MACE at follow-up.
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Affiliation(s)
- Xu Wang
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | | | - Alessandro Mandurino-Mirizzi
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Division of Cardiology, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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34
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Sen G, Veitch A, Claridge S. Coronary arteriovenous fistula with associated aneurysm. BMJ Case Rep 2021; 14:e246048. [PMID: 34531240 PMCID: PMC8449937 DOI: 10.1136/bcr-2021-246048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gautam Sen
- Cardiology, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Alice Veitch
- Radiology, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Simon Claridge
- Cardiology, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
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35
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Miura T, Mitsui H, Tauchi Y, Ishigami S, Yamauchi Y, Kusuyama T, Kohno H, Hagikura A, Kawai Y. [Surgical Treatment for Giant Coronary Aneurysm Complicated by Acute Myocardial Infarction and Cardiopulmonary Arrest:Report of a Case]. Kyobu Geka 2021; 74:705-708. [PMID: 34446627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Giant coronary aneurysm is rare, but a life-threatening disease. We report a 67-year-old man with 39 mm coronary aneurysm. He was presented to our facility with acute coronary syndrome complicated by cardiogenic shock. Angiography demonstrated giant coronary aneurysm and occlusion of the right coronary artery. After cardiopulmonary resuscitation and cardiopulmonary support (PCPS), emergent excision of aneurysm and coronary artery bypass grafting was performed. The postoperative course was good without complications. Most giant coronary artery aneurysms are asymptomatic but some patients present with angina pectoris, sudden death, fistula formation, pericardial tamponade, compression of surrounding structures, or congestive heart failure. But once complications, such as thrombosis, distal embolization, fistula formation or rupture occurred, it is difficult to save life without aggressive surgery. At present, there are no specific guidelines for the treatment of giant coronary aneurysm. Surgical correction is a preferred approach for the treatment of giant coronary artery aneurysms.
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Affiliation(s)
- Takuya Miura
- Department of Cardiovascular Surgery, Tsukazaki Hospital, Himeji, Japan
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36
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Sakaki K, Hanayama N. [Giant Right Coronary Artery Aneurysm Complicated by Acute Myocardial Infarction:Report of a Case]. Kyobu Geka 2021; 74:550-553. [PMID: 34193793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The patient was a 45-year-old man who was transported by ambulance to a nearby clinic owing to sudden chest pain. He was diagnosed with myocardial infarction and giant coronary artery aneurysm by coronary arteriogram and underwent an emergency intervention for the myocardial infarction. The patient was referred to our hospital. Intraoperative findings showed the mass-like right coronary artery aneurysm at the anterior to the right atrium. The origin of the right coronary artery was ligated in addition to the fenestration and the proximal and distal regions of the coronary artery aneurysm. It has been reported that coronary artery aneurysms are usually asymptomatic and are often discovered by chance during screenings, such as echocardiography, computed tomography, and coronary arteriogram. Here, we report a surgical case of giant right coronary artery aneurysm complicated by acute myocardial infarction.
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Affiliation(s)
- Kenjiro Sakaki
- Department of Cardiovascular Surgery, Kanto Rosai Hospital, Kawasaki, Japan
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37
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Urashita S, Suzuki R, Hirayama R, Matsukawa M, Sakaguchi T, Uekihara K, Miyamoto T, Wada T, Nakajima M. [Cardiac Tamponade due to a Ruptured Giant Coronary Artery Aneurysm]. Kyobu Geka 2021; 74:424-428. [PMID: 34059584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We report a case of a ruptured coronary artery aneurysm. An 87-year-old woman suffered from cardiac tamponade due to a ruptured coronary artery aneurysm. Coronary angiography showed a giant coronary aneurysm without coronary artery fistula. Emergency surgery was performed through median sternotomy. We performed aneurysmectomy and ligation of the perfusion arteries under cardiopulmonary bypass. The patient's postoperative course was uneventful. We also reviewed nine cases of ruptured coronary artery aneurysm without coronary artery fistula in Japan. The disease is a rare clinical state and considered to be an indication for emergency surgery.
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Affiliation(s)
- Shuichi Urashita
- Department of Cardiovascular Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
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38
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Abe K, Hirai K, Kawasaki T. Stent Fracture Induced Infected Pseudo Coronary Artery Aneurysm with Massive Abscess Successfully Treated by Coronary Stent Graft. Intern Med 2021; 60:1403-1407. [PMID: 33250463 PMCID: PMC8170258 DOI: 10.2169/internalmedicine.5790-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Infected pseudo coronary artery aneurysm (CAA) is extremely rare, and currently, there is no established treatment. We experienced a rare case of an infected pseudo CAA brought on due to a stent fracture. Following prolonged successful antimicrobial administration, which proved effective in successfully treating the patient, we performed coronary stent graft placement. Although a surgical procedure should fundamentally be the first course of action considered in such cases, when there are concerns as to the degree of invasiveness, our strategy represents a viable option.
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Affiliation(s)
- Kensho Abe
- Division of Cardiology, Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, Japan
| | - Keisuke Hirai
- Division of Cardiology, Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, Japan
| | - Tomohiro Kawasaki
- Division of Cardiology, Cardiovascular and Heart Rhythm Center, Shin-Koga Hospital, Japan
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39
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Han F, Yan B. Three novel ATG16L1 mutations in a patient with acute myocardial infarction and coronary artery ectasia: A case report. Medicine (Baltimore) 2021; 100:e24497. [PMID: 33530273 PMCID: PMC7850772 DOI: 10.1097/md.0000000000024497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a specific type of coronary artery disease (CAD) caused by the rupture of coronary atherosclerotic plaques. Coronary artery ectasia (CAE) is a rare phenotype of cardiovascular disease that may promote thrombosis and inflammatory responses leading to myocardial infarction due to abnormal dilatation of blood vessels and coronary blood flow disorders. It is a complicated disease and shows interaction between genetic and environmental factors. PATIENT CONCERNS A 34-year-old male patient was admitted to our hospital on May 12, 2016, with complaints of chest pain for 1 hour duration. DIAGNOSIS Coronary angiography through the emergency medical service (EMS) system showed 100% occlusion at the first turning point of the right coronary artery (RCA), along with tumor-like expansion of the proximal segment of the RCA and the end of the left main (LM) artery. The patient was diagnosed with AMI and CAE. Three-point mutations in the ATG16L1 gene were identified by direct sequencing. INTERVENTIONS After admission, the patient underwent emergency green channel coronary angiography and percutaneous coronary intervention (PCI) to assess and unblock the stenosis and occlusion of the RCA lumen, but no stenting was performed because the catheter could not pass the second inflection point of the RCA. Aspirin enteric-coated tablets, clopidogrel sulfate tablets, tirofiban hydrochloride, and low molecular weight heparin calcium were given as anticoagulant and antiplatelet therapy. Atorvastatin calcium tablets were used to regulate blood lipid levels. Perindopril and spironolactone were used to inhibit the renin-angiotensin-aldosterone system (RAAS) to reverse myocardial remodeling. Acetylcholinesterase inhibitors (ACEI) and beta blockers were administered to resist ventricular remodeling and improve cardiac function and prognosis after the patient's blood pressure and heart rhythm were stabilized. OUTCOMES After active rescue treatment, the patient recovered and was discharged. A coronary angiogram performed 2 years later showed that the RCA blood flow was restored, and the patient had recovered well. CONCLUSION Three-point mutations in the ATG16L1 gene were identified in a patient with AMI and CAE, which extended the mutation spectrum of the ATG16L1 gene. Hence, the etiology of coronary artery aneurysmal dilatation is worthy of further investigation.
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Affiliation(s)
- Falan Han
- Cheeloo College of Medicine, Shandong University, Jinan
| | - Bo Yan
- Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment
- The Center for Molecular Genetics of Cardiovascular Diseases
- Shandong Provincial Sino-US Cooperation Research Center for Translational Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
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40
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Xu M, Liu J, Pan L, Yang S. Peripheral follicular cytotoxic T -like cells in Kawasaki disease with coronary artery aneurysms: A case report. Medicine (Baltimore) 2020; 99:e23714. [PMID: 33350751 PMCID: PMC7769354 DOI: 10.1097/md.0000000000023714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Kawasaki disease (KD) is the leading cause of acquired heart abnormalities during childhood. The infiltration of CD8+ T cells plays an essential role in the formation of coronary aneurysms. Follicular cytotoxic T (Tfc) cells are a newly defined subset of CD8+ T cells that express CXC-chemokine receptor 5. The role of Tfc cells in KD is unclear. However, in this report, we present 2 KD children with sustained coronary artery aneurysms (CAA), and we found that their peripheral C-X-C Chemokine Receptor 5+ T cells contained quite amounts of CD4 negative cells. Importantly, these cells have never been reported in KD. PATIENTS CONCERNS Case 1 was a 3-year-old boy with a complaint of continuous fever for 6 days and conjunctival injection for 3 days. Case 2 was a 6-month-old boy who was hospitalized because of persistent fever for 5 days, rashes and conjunctival injection for 1 day. DIAGNOSIS Case 1 was diagnosed with KD according to typical symptoms and signs including fever over 5 days, conjunctival injection, rashes, swelling cervical lymph nodes and a strawberry tongue. Case 2 had atypical symptoms including persistent fever for 5 days, rashes and conjunctival injection, and he was diagnosed with KD based on the echocardiographic findings. INTERVENTION Both the 2 patients received intravenous immunoglobulin and oral aspirin. Besides, case 1 was given the second infusion of intravenous immunoglobulin, intravenous prednisolone and low-molecular-weight heparin. OUTCOMES The CAA of case 1 did not regress until the 12th month after disease onset. The CAA of patient 2 began to regress at the third month after disease onset. During the months from disease onset to the recent follow-up, no cardiovascular events had occurred. CONCLUSIONS We speculate that Tfc cells may be associated with the formation of CAA. Further studies with larger sample size and functional analysis of these cells are needed.
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Sawada Y, Suzuki H, Teranishi S, Mizumoto T, Shimpo H. [Surgical Repair of Giant Coronary Artery Aneurysm Associated with Coronary-pulmonary Artery Fistulae;Report of a Case]. Kyobu Geka 2020; 73:1018-1021. [PMID: 33268754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 61-year-old woman was referred to our hospital with a complaint of chest compression. Coronary angiography revealed a giant coronary artery aneurysm, located in the middle of a coronary-pulmonary artery fistula originating from the right coronary artery. Another fistula was also shown between the left anterior descending artery and the pulmonary artery. Surgical correction was indicated due to the risks of the aneurysmal rupture and coronary events. Under cardiopulmonary bypass, suture-closure of the coronary artery aneurysm and ligations of the fistulae were carried. Postoperative coronary angiography showed no aneurysm or fistula, and she was discharged uneventfully on the 12th postoperative day.
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Affiliation(s)
- Yasuhiro Sawada
- Department of Cardiovascular Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan
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42
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Affiliation(s)
- Daniyar Gilmanov
- Cardiac Surgery Department, Vito Fazzi Hospital, 1, Piazza F. Muratore, Lecce 73100, Italy
| | - Cosimo Greco
- Cardiac Surgery Department, Vito Fazzi Hospital, 1, Piazza F. Muratore, Lecce 73100, Italy
| | - Alessandro Cafaro
- Interventional Cardiology Department, Vito Fazzi Hospital, 1, Piazza F. Muratore, Lecce 73100, Italy
| | - Salvatore Zaccaria
- Cardiac Surgery Department, Vito Fazzi Hospital, 1, Piazza F. Muratore, Lecce 73100, Italy
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43
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Affiliation(s)
| | - Ibrahim M Saeed
- Saint Luke's Cardiovascular Consultants, Kansas City, Missouri
| | - Harshal Patil
- Saint Luke's Cardiovascular Consultants, Kansas City, Missouri
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44
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Edraki MR, Mohammadi H, Mehdizadegan N, Ghorashi M, Amoozgar H, Borzouee M, Ajami G, Keshavarz K, Dehghani E, Bahrami R. Japanese Kawasaki Disease Scoring Systems: Are they Applicable to the Iranian Population? Arch Iran Med 2020; 23:31-36. [PMID: 31910632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Kawasaki disease (KD) is the most frequent cause of coronary artery aneurysm (CAA) in children. This study tried to evaluate the accuracy of different KD scores developed for prediction of CAA, in an Iranian population. METHODS This is a cross-sectional retrospective investigation on pediatric patients with a diagnosis of KD. Clinical manifestations, laboratory, and echocardiographic data were recorded. Five Kawasaki scores, including Kobayashi, Egami, Sano, Nakano, and Harada, were assessed and analyzed in relation to CAA and intravenous immunoglobulin (IVIG) resistance. RESULTS During five years, we recruited 121 cases of KD under 13 years of age. The rates of CAA and IVIG resistance were 16.5%, and 13.2% respectively. The IVIG resistance group was significantly younger than responder patients. All five scores had low sensitivity in predicting CAA or IVIG resistant cases; the highest sensitivity pertained to the Harada score with 50% sensitivity and 59% specificity (the area under the curve: 0.545, with a 95% confidence interval: 0.423 to 0.667) in predicting CAA, which is lower than the usual acceptable criteria for a screening test. The specificity of all other scores were more than 85% in predicting CAA or IVIG resistance. Gender, fever before therapy and laboratory data showed no significant difference between the groups. CONCLUSION The Kobayashi, Egami, Sano, Nakano and Harada scores have limited usefulness in the Iranian population to predict high risk patients for coronary artery involvement or IVIG resistance; in our study, age under one year was a risk factor for IVIG resistance.
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Affiliation(s)
- Mohammad Reza Edraki
- Neonatology and Cardiac Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Mohammadi
- Neonatology and Cardiac Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Mehdizadegan
- Neonatology and Cardiac Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Ghorashi
- Neonatology and Cardiac Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Amoozgar
- Neonatology and Cardiac Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Borzouee
- Neonatology and Cardiac Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Ajami
- Neonatology and Cardiac Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kambiz Keshavarz
- Neonatology and Cardiac Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Dehghani
- Neonatology and Cardiac Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Bahrami
- Neonatology and Cardiac Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
RATIONALE Coronary artery aneurysms (CAAs) are uncommon in patients with acute coronary syndrome (ACS). We describe the clinical features and outcomes of stent-assisted coil embolization of a CAA in the trigeminal position. PATIENT CONCERNS We present a 73-year-old woman with a history of paroxysmal episodes of precordial pain since 1 year. Coronary computed tomography angiography (CTA) revealed an aneurysm (diameter: 9 mm) at the junction of the distal left main coronary artery and the anterior descending branch. Troponin I, CK-MB, creatinine and routine blood investigations were within the normal range. DIAGNOSIS Coronary artery aneurysm in the left main trigeminal position. INTERVENTIONS The patient was treated with stent-assisted coil embolization. OUTCOMES After complete filling of the aneurysm with coil, the microcatheter was withdrawn and the stent released in the descending branch. Two stents were successfully implanted. LESSONS There is no clear consensus on the optimal therapy for patients with CAAs. Clinicians should be aware of the possible complications of stent-assisted coil embolization of CAA in the main trunk of the coronary artery.
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Affiliation(s)
| | - Minjie Liu
- Department of Ultrasound, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | | | | | | | - Dongyu Jia
- Department of Biology, Georgia Southern University, Statesboro, GA
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46
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Inoue T, Miyake T, Mushiake S. A case of coronary-pulmonary artery fistula with coronary artery aneurysm detected for Kawasaki disease remote phase. J Clin Ultrasound 2019; 47:508-510. [PMID: 31032930 DOI: 10.1002/jcu.22728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/10/2019] [Accepted: 04/14/2019] [Indexed: 06/09/2023]
Abstract
Follow-up echocardiography showed two coronary-pulmonary artery fistulae and a coronary artery aneurysm in a 12-year-old boy who had been diagnosed with Kawasaki disease without persistent coronary artery lesion at the acute phase when he was 6-months-old. Left coronary arteriogram confirmed the fistulae and the 4.3 × 6.3 mm aneurysm. Results show that the fistula is associated with Kawasaki disease.
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Affiliation(s)
- Tomohiro Inoue
- Department of Pediatrics, Kindai University Nara Hospital, Ikoma, Japan
| | - Toshiharu Miyake
- Department of Pediatrics, Kindai University Nara Hospital, Ikoma, Japan
| | - Sotaro Mushiake
- Department of Pediatrics, Kindai University Nara Hospital, Ikoma, Japan
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47
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Endo H, Dohi T, Dohi S, Wada H, Doi S, Kato Y, Okai I, Iwata H, Okazaki S, Isoda K, Yamamoto T, Miyauchi K, Amano A, Daida H. Clinical indicators and coronary angiographic features of expansive arterial remodelling in patients with abdominal aortic aneurysms. PLoS One 2019; 14:e0219730. [PMID: 31310617 PMCID: PMC6634394 DOI: 10.1371/journal.pone.0219730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022] Open
Abstract
The co-existence of expansive arterial remodelling in both coronary arteries (CAs) and the abdominal aorta has already been reported, although the clinical indicators and quantitative analysis have not been well studied. We therefore aimed to clarify the clinical and anatomical characteristics of patients with abdominal aortic aneurysms (AAAs). 123 AAA patients who underwent coronary angiography were compared to 123 control patients selected by propensity score matching. CA diameters of all 3 vessels were measured by quantitative coronary angiographic analysis. Coronary artery ectasia (CAE) was defined as local or generalized aneurysmal change of the CAs. Excessive expansive CA remodelling was defined as the maximal diameter of the right or left circumflex artery in the upper 75th percentile (>4.8 mm). Multivariable logistic regression analyses were used to determine predictors of CAE and excessive expansive CA remodelling. The prevalences of CAE and excessive expansive CA remodelling were significantly higher in the AAA group than in the non-AAA group (28% vs. 8% and 31% vs. 19%; both p<0.05). On multivariable analysis, the presence of AAA (odds ratio (OR), 4.56; 95% confidence intervals (95%CI) 2.18-10.4) and body mass index (BMI) (OR, 1.11; 95%CI 1.03-1.21) were independently associated with CAE, and higher high-sensitivity C-reactive protein (OR, 2.19; 95%CI 1.08-4.52) and BMI (OR, 1.11; 95%CI 1.02-1.21) were independently associated with excessive expansive CA remodelling. In conclusions, this study showed a higher prevalence of ectatic CA disease in AAA patients and suggests that higher inflammation and obesity are associated with expansive arterial remodelling in coronary arteries.
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Affiliation(s)
- Hirohisa Endo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
- * E-mail:
| | - Shizuyuki Dohi
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Iwao Okai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Hongo, Bunkyo-ku, Tokyo, Japan
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48
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Fernandez-Cooke E, Barrios Tascón A, Sánchez-Manubens J, Antón J, Grasa Lozano CD, Aracil Santos J, Villalobos Pinto E, Clemente Garulo D, Mercader Rodríguez B, Bustillo Alonso M, Nuñez Cuadros E, Navarro Gómez ML, Domínguez-Rodríguez S, Calvo C. Epidemiological and clinical features of Kawasaki disease in Spain over 5 years and risk factors for aneurysm development. (2011-2016): KAWA-RACE study group. PLoS One 2019; 14:e0215665. [PMID: 31107862 PMCID: PMC6527399 DOI: 10.1371/journal.pone.0215665] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/07/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology affecting mainly children less than 5 years of age. Risk factors for cardiac involvement and resistance to treatment are insufficiently studied in non-Japanese children. OBJECTIVE This study aimed to investigate the epidemiology, clinical features and risk factors for resistance to treatment and coronary artery lesions (CAL) in KD in Spain. METHODS Retrospective study (May 2011-June 2016) of all patients less than 16 years of age diagnosed with KD included in KAWA-RACE network (84 Spanish hospitals). RESULTS A total of 625 cases were analyzed, 63% were males, 79% under 5 year-olds and 16.8% younger than 12 months. On echocardiographic examination CAL were the most frequent findings (23%) being ectasia the most common (12%). Coronary aneurysms were diagnosed in 9.6%, reaching 20% in infants under 12 months (p<0.001). A total of 97% of the patients received intravenous immunoglobulin (IVIG) with a median number of days from fever onset to IVIG administration of 7.2. A second dose was given to 15.7% and steroids to 14.5% patients. Only 1.4% patients received infliximab. No deaths were reported. A multivariate analysis identified anemia, hypoalbuminemia, hyponatremia, higher creatinine and procalcitonin as independent risk factors for treatment failure and length under 103 cm, hemoglobin < 10.2 mg/dL, platelets > 900,000 cells/mm3, maximum temperature < 39.5°C, total duration of fever > 10 days and fever before treatment ≥ 8 days as independent risk factors for developing coronary aneurysms. CONCLUSIONS In our population, children under 12 months develop coronary aneurysms more frequently and children with KD with anemia and leukocytosis have high risk of cardiac involvement. Adding steroids early should be considered in those patients, especially if the treatment is not started before 8 days of fever. A score applicable to non-Japanese children able to predict the risk of aneurysm development and IVIG resistance is necessary.
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Affiliation(s)
| | - Ana Barrios Tascón
- Department of Pediatrics, Hospital Universitario Infanta Sofia, Madrid, Spain
| | - Judith Sánchez-Manubens
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain
- Department of Pediatric Rheumatology, Hospital Parc Tauli, Sabadell, Spain
| | - Jordi Antón
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Sara Domínguez-Rodríguez
- Fundación de Investigación Hospital 12 Octubre (Madrid, Spain), Fondazione PENTA ONLUS, Padova, Italy
| | - Cristina Calvo
- Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
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49
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Bekki M, Tahara N, Tahara A, Honda A, Igata S, Sugiyama Y, Nakamura T, Sun J, Kurata S, Fujimoto K, Abe T, Tanaka H, Suda K, Fukumoto Y. Anti-inflammatory effect of statin in coronary aneurysms late after Kawasaki disease. J Nucl Cardiol 2019; 26:671-673. [PMID: 29667011 DOI: 10.1007/s12350-018-1278-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Munehisa Bekki
- Department of Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Nobuhiro Tahara
- Department of Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Atsuko Tahara
- Department of Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Akihiro Honda
- Department of Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Sachiyo Igata
- Department of Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Yoichi Sugiyama
- Department of Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Tomohisa Nakamura
- Department of Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Jiahui Sun
- Department of Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
| | - Seiji Kurata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Hiroyuki Tanaka
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Kenji Suda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.
| | - Yoshihiro Fukumoto
- Department of Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan
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50
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Schutte T, Ramawadhdoebe S, Schotten J. [Chest pain after angiography without anomalies]. Ned Tijdschr Geneeskd 2019; 163:D2975. [PMID: 30875164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Myocardial infarction can be categorized based on ECG-findings (presence or absence of ST-elevations on STEMI/NSTEMI) or on the results from coronary angiography (CAG) (presence or absence of obstructive atherosclerosis). Myocardial infarction without significant obstruction on CAG (Myocardial Infarction with Non-Obstructive Coronary Arteries/Atherosclerosis; MINOCA) occurs in up to a quarter of patients with myocardial infarcts. These patients have a higher risk of future heart diseases; up to a quarter of MINOCA patients suffer from heart diseases during a median follow-up of four years. CASE DESCRIPTION We describe a 55-year old woman, who suffered from two myocardial infarctions in one week. The first time, no ST-elevation was detected with ECG and CAG was without abnormalities (MINOCA). Five days later, she experienced the same symptoms; ECG showed ST-elevations and CAG revealed a coronary dissection. CONCLUSION Patients with a myocardial infarction without coronary obstruction (MINOCA) have a higher risk of future heart diseases. In this case, a coronary dissection.
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Affiliation(s)
- Tim Schutte
- Zaans Medisch Centrum, afd. Interne Geneeskunde, Longgeneeskunde en Cardiologie, Zaandam
- Contact: T. Schutte
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