Aortic pressures within a giant right coronary artery aneurysm

Giant right coronary artery (RCA) aneurysm is a rare coronary artery pathology. We describe a 45-year-old gentleman who presented with unstable angina of recent onset. Diagnostic workup including chest computed tomography angiography and left heart catheterization demonstrated three-vessel coronary artery disease with giant proximal RCA aneurysm. In the view of the severity of the coronary artery disease and the risk of rupture associated with the giant RCA aneurysm and the clinical presentation, the patient was successfully treated by coronary artery bypass surgery. During this procedure, the RCA aneurysm was ligated at both inflow and outflow. The patient recovered well and was discharged home.

Giant coronary artery aneurysms, defined as diameters larger than 20 mm, are exceedingly rare and constitute a life-threatening occurrence. This case involves a patient with a giant right coronary artery (RCA) aneurysm and multivessel coronary artery disease, successfully managed by surgical intervention through quintuple coronary artery bypass grafting (CABG). A 65-year-old male with a history of hypertension presented with acute-onset chest pain. The initial workup revealed an inferolateral ST-segment elevation myocardial infarction (STEMI). The patient underwent emergency coronary angiography revealing a high-grade stenosis in the proximal and mid left anterior descending coronary artery, along with a remarkably tortuous and enlarged mid to distal RCA aneurysm measuring (21mm wide x 20mm long) and featuring significant post aneurysmal stenosis. Attempts at percutaneous angioplasty were unsuccessful due to extensive thrombosis in the RCA. The patient continued to experience active chest pain, necessitating the placement of an intra-aortic balloon pump in the right common femoral artery, the insertion of a temporary pacemaker wire to address bradycardia, and the initiation of pressor support for hypotension. Additionally, intravenous heparin and antiplatelet therapy were administered. Finally, the patient underwent a quintuple CABG to address the multivessel disease. Coronary artery aneurysm is an uncommon yet potentially perilous condition. The selection of appropriate management and intervention is crucial for averting fatal consequences associated with coronary artery aneurysms.

Giant Aneurysm of the Left Atrial Branch of the Left Circumflex Artery With Fistula

<p>Coronary artery aneurysm (CAA) is a rare entity, defined as localized dilation that exceeds the normal vessel diameter by a factor of 1.5. A giant CAA is described as a very large dilation, when diameter exceeds 20 mm. CAA has a preva-lence of 0.02% [Markis 1976]. Different factors may lead to CAA formation, including Kawasaki disease, atherosclerosis, congenital malformations, autoimmune and infectious disor-ders, and percutaneous interventions [Hartnell 1985]. Man-agement of these patients remains controversial due to a lack of data from large series studies.</p><p>We reported a case of a young female patient, who pre-sented with an acute inferior infarction and was diagnosed with a giant right coronary artery (RCA) aneurysm. She underwent aneurysmectomy and revascularization on a beat-ing heart through a right lateral thoracotomy. Due to the minimally invasive nature of this procedure, the patient was able to recover quickly without substantial cosmetic changes.</p>

Coronary artery aneurysms (CAAs) are rare, with giant CAAs being even rarer. The precise pathophysiology of this phenomenon is still unknown. CAAs are seldom reported life-threatening abnormalities of the cardiovascular system. We herein present a case of a 74-year-old man who presented at the hospital complaining of chest pain. An adenosine thallium scan revealed a small, reversible defect in the inferior wall of the left ventricle extending into the apex, consistent with ischemia. Echocardiography uncovered a large right coronary artery (RCA) aneurysm, measuring 5.6 × 7.5 cm. Diagnostic coronary angiography confirmed the presence of a large RCA aneurysm and aneurysmal dilation of the left anterior descending and circumflex arteries with no flow-limiting lesions. A reversed saphenous vein interposition graft was placed from the ascending aorta to the right posterior descending artery. The RCA aneurysmal sac was resected and sent to pathology, which uncovered myxoid degeneration of the media as well as thrombus formation. No complications were encountered during the procedure. Early diagnosis is vital to avoid fatal complications of CAAs, and therapeutic approaches are currently individualized in view of absence of evidence-based management strategies.

Resection of Giant Coronary Artery Aneurysms in a Takayasu's Arteritis Patient

Giant Thrombotic Right Coronary Aneurysm in an Infant with Undiagnosed Incomplete Kawasaki Disease and Rapidly Progressive Cardiovascular Collapse

Successful Revascularization of Multiple Coronary Artery Aneurysms Using a Combination of Surgical Strategies

Patient: Male, 64-year-oldFinal Diagnosis: Huge coronary aneurysmSymptoms: Chest discomfort • dyspneaMedication: Losar 25 mg twice daily • Amlodipine 5 mg twice daily • Aspirin 80 mg daily • Atorovastatin 20 mg daily • Pantaprazole 20 mg dailyClinical Procedure: Coronary artery bypass graft surgerySpecialty: Cardiac Surgery • CardiologyObjective:Rare diseaseBackground:Giant coronary artery aneurysm (GCAA) is a rare disease, with an incidence of 0.02% in the general population. GCAA is defined as when the diameter of the coronary artery is more than 4 times the adjacent part or more than 8 mm. There are several causes of GCAA, with atherosclerosis being the most common. Patients with giant coronary artery aneurysms can be asymptomatic or develop chest pain, dyspnea, and palpitations. Complications of GCCA include myocardial infarction, thrombosis, and sudden death, so early treatment is necessary to prevent mortality. There is no standard surgical approach for a giant coronary artery aneurysm.Case Report:A 64-year-old man with hypertension, opium addiction, morbid obesity (body weight 151 kg and BMI 46), and benign prostate hyperplasia presented with a giant coronary aneurysm in coronary angiography. The patient underwent cardiac surgery, and a 42-mm coronary aneurysm was detected. The aneurysm had many orifices that opened to the left main coronary artery, left circumflex artery, LAD, the diagonal branch of the LAD, and the septal branch of the LAD. Aneurysmectomy and coronary artery bypass graft were successfully performed.Conclusions:Giant coronary artery aneurysms are rare. Patients with giant coronary artery aneurysms may experience sudden death due to myocardial infarction and other cardiovascular complications due to ischemia. Because it is rare, there is no standard surgical approach for a giant coronary artery aneurysm. Further studies need to focus on standardized surgical management of patients with giant coronary artery aneurysms.

Introduction: Coronary artery aneurysm (CAA) is defined as a dilation exceeding the diameter of an adjacent referent portion by more than 1.5 times. In rare circumstances CAA can be defined as giant, when exceed 8-20 mm. Here we report a rare case of a casual diagnosis of asymptomatic giant right coronary artery aneurysm who underwent successful surgical treatment. Case report: A 66 y.o. male was referred with a giant mediastinic mass revealed at a CT scan. The patient claimed to be asymptomatic. Pre-operative evaluation included: a) TT-Echocardiography showing a big ovalar mass next to the atrioventricular groove with blood flow from RCA; b) Ecg-gated-CTscan which showed a big (14x12.5 cm) contrast-enhanced mass arising from the RCA confirmed at c) coronary angiography. After careful Heart Team evaluation, surgical correction by mean of aneurism ligation, was deemed to be the only treatment option. Surgical Treatment: CPB was established via right axillary artery and peripheral femoral vein cannulation. Median sternotomy allowed the exposition of the huge aneurysm, nourished by the right coronary artery, with a complete dislocation of aorta. Surgical correction included aneurysm incision, exclusion of all communications and ligation. CABG on RCA was not necessary. Following uneventful course, post-operative CT scan showed no evidence of active blood reperfusion to the aneurysmatic remnant. Conclusion: CAAs are rare but potentially catastrophic conditions. Once the diagnosis is made, despite the lack of agreed consensus, early treatment with accurate preoperative evaluation is pivotal in order to optimize the outcome.

Objective To observe the mid- and long-term changes of giant coronary artery aneurysm(GCAA) caused by Kawasaki disease(KD) and to provide preventive basis for cardiac accidents of KD-affected adolescents. Methods Twelve cases of KD with GCAA [10 boys, 2 girls; 1-10 years old; mean age: (4.05±2.50) years old] were followed up by coronary angiography (CAG), echocardiography and electrocardiogram for 2-10 years to and the changes of the coronary artery lesion were analyzed. Results The findings showed that 2 cases were single coronary artery aneurysm and 10 cases had multiple coronary artery aneurysms on both sides by echocardiography.Among them 8 cases showed segmental stenosis in the right coronary artery with varying degrees by coronary angiography, including 3 cases with coronary recanalization after right coronary artery complete occlusion, 4 cases with segmental local stenosis, and 1 case with thrombotic occlusion and tufted neovascularization.And in 9 cases of coronary artery aneurysms were still present after treatment, and among them the blood flow filling in 4 cases was slowing down in the left anterior descending arteries.Only 1 case with coronary artery aneurysms on both sides became expanded mildly, without stenosis or other lesions.In this observation, all of the cases had no symptoms or any activity limitation.One case was found pathologic Q wave and the other 11 cases left normal by resting electrocardiogram.The results of resting electrocardiogram in 11 cases were normal by pharmacologic stress electrocardiogram except that 1 case showed multi-lead S-T segment depression and T wave flat.Compared with coronary angiography in the same period, 12 cases showed proximal morphological changes in coronary artery and 5 cases with wall motion abnormalities by echocardiography.This study showed that echocardiography was not sensitive enough for mid- and distal-stenosis examination because it failed to provide any useful information for 4 cases affected by segmental stenosis and neovascularization. Conclusions The GCAA caused by KD will be lasting for a long time after acute stage, including persisting GCAA, recovering GCAA, occlusion, stenosis and neovascularization.The sensitivity of echocardiography and electrocardiogram are not enough to find coronary morphology and function of KD sequelae damages.CAG is important for follow-up observations of KD with GCAA. Key words: Kawasaki disease; Giant coronary artery aneurysm; Coronary angiography; Follow-up

Bilateral congenital coronary artery fistulae complicated with a giant coronary artery aneurysm is a very rare condition. A coronary artery aneurysm is a coronary artery dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. The complications associated with a coronary artery aneurysm include thrombosis, embolization, rupture, vasospasm, congestive heart failure and infectious endocarditis. We report on a 63-year-old woman presenting with severe heart failure related to bilateral coronary artery fistulae. A giant coronary aneurysm was noted in the right coronary artery, and a tortuous coronary artery fistula was noted in the left coronary artery. Symptoms were relieved after surgical intervention for bilateral coronary artery fistulae.

Giant left coronary artery aneurysms: Review of the literature and report of a rare case diagnosed by transthoracic echocardiography

GIANT RIGHT CORONARY ARTERY ANEURYSM PRESENTING WITH ANGINA

Coronary artery aneurysm (CAA) is focal dilatation of a coronary artery 1.5 times or more its normal size (Res Cardiovasc Med, 2016; 5: e32086). Coronary artery aneurysm is found in 1.2-4.9% of diagnostic coronary angiography and 1.4% at post-mortem (Heart Views, 2014; 15: 13; Clin Cardiol, 2015; 29: 439). The proximal and middle segments of the right coronary artery (RCA) are most commonly involved, followed by the proximal left anterior descending (LAD) and the left circumflex arteries. The left main stem rarely develops aneurysms (Clin Cardiol, 2015; 29: 439). A giant aneurysm is a CAA>2cm. Giant coronary artery aneurysms (GCAA) are rare (incidence 0.02%) although cause serious complications. [4] Given the rarity of this disease, there is limited information in the literature on its presentation and there is no consensus on its optimal management option. We report a case of a GCAA with an atypical presentation and describe its management. This will add to the current small database on CAA to provide clinicians a better insight on the disease.