Left Coronary Artery Aneurysm Research Articles

Hemodynamics simulation and analysis of left coronary artery aneurysms with concomitant stenosis

The hemodynamic parameters in arteries are difficult to measure non-invasively, and the analysis and prediction of hemodynamic parameters based on computational fluid dynamics (CFD) has become one of the important research hotspots in biomechanics. This article establishes 15 idealized left coronary artery bifurcation models with concomitant stenosis and aneurysm lesions, and uses CFD method to numerically simulate them, exploring the effects of left anterior descending branch (LAD) stenosis rate and curvature radius on the hemodynamics inside the aneurysm. This study compared models with different stenosis rates and curvature radii and found that as the stenosis rate increased, the oscillatory shear index (OSI) and relative residence time (RRT) showed a trend of increase; In addition, the decrease in curvature radius led to an increase in the degree of vascular curvature and an increased risk of vascular aneurysm rupture. Among them, when the stenosis rate was less than 60%, the impact of stenosis rate on aneurysm rupture was greater, and when the stenosis rate was greater than 60%, the impact of curvature radius was more significant. Based on the research results of this article, it can be concluded that by comprehensively considering the effects of stenosis rate and curvature radius on hemodynamic parameters, the risk of aneurysm rupture can be analyzed and predicted. This article uses CFD methods to deeply explore the effects of stenosis rate and curvature radius on the hemodynamics of aneurysms, providing new theoretical basis and prediction methods for the assessment of aneurysm rupture risk, which has important academic value and practical guidance significance.

Left Coronary Artery Aneurysm Causing a Third Mogul.

Left Coronary Artery Aneurysm Causing a Third Mogul.

On-pump beating-heart technique for managing a ruptured left coronary artery aneurysm.

We present the case of an 86-year-old woman with a ruptured left coronary artery aneurysm associated with coronary-pulmonary artery fistula. She was transferred to our hospital with complaints of chest discomfort. Echocardiography revealed cardiac tamponade, and subsequently, a bloody pericardial effusion was drained. Coronary angiography and computed tomography revealed a ruptured left coronary artery aneurysm originating from a branch of the proximal left anterior descending artery and a coronary-pulmonary artery fistula. In the emergency operation, under cardiopulmonary bypass, the inlet and outlet vessels were ligated, and the aneurysm was closed without arresting the heart. By utilizing cardiopulmonary bypass, the pulmonary trunk was easily decompressed, and dissection around the aneurysm and identification of the inlet and outlet vessels was facilitated without cardiac arrest. Thus, to conclude, an on-pump beating-heart technique should be considered in such cases.

Giant Aneurysm of Left Main Coronary Artery in a Patient With Prior Operation for 4-Valve Endocarditis

Left main coronary artery aneurysm is an unusual complication of infective endocarditis. Although this type of aneurysm is often asymptomatic, rupture and thrombus formation that result in myocardial infarction are known complications; therefore, prompt recognition and surgical intervention are warranted. This report describes a patient who presented with a giant left main coronary artery aneurysm 3.5 years after being treated for 4-valve endocarditis. The management and technical aspects of this challenging case are discussed here.

Extremely distal left coronary artery aneurysm: beware of coronary computed tomography angiography incidental findings

article: Extremely distal left coronary artery aneurysm: beware of coronary computed tomography angiography incidental findings - Journal of Radiological Review 2022 December;9(4):211-2 - Minerva Medica - Journals

Surgical repair for left coronary artery-right atrium fistula with giant coronary aneurysm

BackgroundCoronary artery fistula is a rare coronary anomaly which is defined as a communication between coronary artery and other heart chambers or vascular structures. The coronary artery which supply the fistula with blood can dilated, as a consequence, coronary aneurysm developed.Case introductionCoronary artery fistula is frequently asymptomatic in its early stage, here we report a 26-year-old woman with left coronary artery fistula and left coronary artery aneurysm who presented in our hospital with dyspnea, fatigue and palpitation. The orifice of fistula was closed by continuous suture via right atriotomy. The wall of the aneurysm and enlarged LCA were partially resected along its longitudinal axis so that we can reduce the diameter of LCA to approximately normal.ConclusionThis technique provides a safe method for surgical repair of the giant coronary artery aneurysm with CAF.

Coil embolization to giant left anterior descending artery and left circumflex artery coronary artery aneurysm after failed coronary aneurysmal repair in IgG4-related disease: a case report

BackgroundIgG4-related disease (IgG4-RD) is a chronic fibroinflammatory condition with multiple-organ involvement. Rupture of coronary artery aneurysms (CAAs) in IgG4-RD is rare.Case summaryA 65-year-old man with IgG4-RD has suffered from recurrent episodes of arterial aneurysms since 2003. He presented with chest pain and hypotension caused by localized cardiac tamponade at right ventricle free wall due to the rupture of coronary artery aneurysm (CAA) of left anterior descending artery (LAD). An urgent LAD aneurysm repaired with bovine pericardium and obliterated aneurysmal sac with cryo-acrylate glue was done together with coronary artery bypass grafting (CABG) using saphenous vein graft (SVG) to LAD and SVG to posterior descending artery. Three-month after surgery, the follow-up coronary computed tomography angiography (CCTA) revealed a growing in size of LAD and the second obtuse marginal (OM) branch aneurysm. Heart team discussion agreed to schedule the patient for double coil embolization to LAD and second OM aneurysm under intravascular ultrasound guidance. Both aneurysms were successfully obliterated with vascular coils. Two-week follow-up coronary angiogram showed complete occlusion of LAD aneurysm and near occlusion of the second OM branch aneurysm.DiscussionCoronary artery aneurysm rupture is a life-threatening condition that required prompt detection and treatments. In IgG4-RD patients, acute cardiac tamponade suggesting the rupture of CAA. Coil embolization is an alternative treatment in patients who suffered from recurrent CAA after surgical repair. Serial CCTA is important for early detection of aneurysm in IgG4-RD patients who had vascular involvement.

Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19

Refinement of criteria for multisystem inflammatory syndrome in children (MIS-C) may inform efforts to improve health outcomes. To compare clinical characteristics and outcomes of children and adolescents with MIS-C vs those with severe coronavirus disease 2019 (COVID-19). Case series of 1116 patients aged younger than 21 years hospitalized between March 15 and October 31, 2020, at 66 US hospitals in 31 states. Final date of follow-up was January 5, 2021. Patients with MIS-C had fever, inflammation, multisystem involvement, and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) or antibody test results or recent exposure with no alternate diagnosis. Patients with COVID-19 had positive RT-PCR test results and severe organ system involvement. SARS-CoV-2. Presenting symptoms, organ system complications, laboratory biomarkers, interventions, and clinical outcomes. Multivariable regression was used to compute adjusted risk ratios (aRRs) of factors associated with MIS-C vs COVID-19. Of 1116 patients (median age, 9.7 years; 45% female), 539 (48%) were diagnosed with MIS-C and 577 (52%) with COVID-19. Compared with patients with COVID-19, patients with MIS-C were more likely to be 6 to 12 years old (40.8% vs 19.4%; absolute risk difference [RD], 21.4% [95% CI, 16.1%-26.7%]; aRR, 1.51 [95% CI, 1.33-1.72] vs 0-5 years) and non-Hispanic Black (32.3% vs 21.5%; RD, 10.8% [95% CI, 5.6%-16.0%]; aRR, 1.43 [95% CI, 1.17-1.76] vs White). Compared with patients with COVID-19, patients with MIS-C were more likely to have cardiorespiratory involvement (56.0% vs 8.8%; RD, 47.2% [95% CI, 42.4%-52.0%]; aRR, 2.99 [95% CI, 2.55-3.50] vs respiratory involvement), cardiovascular without respiratory involvement (10.6% vs 2.9%; RD, 7.7% [95% CI, 4.7%-10.6%]; aRR, 2.49 [95% CI, 2.05-3.02] vs respiratory involvement), and mucocutaneous without cardiorespiratory involvement (7.1% vs 2.3%; RD, 4.8% [95% CI, 2.3%-7.3%]; aRR, 2.29 [95% CI, 1.84-2.85] vs respiratory involvement). Patients with MIS-C had higher neutrophil to lymphocyte ratio (median, 6.4 vs 2.7, P < .001), higher C-reactive protein level (median, 152 mg/L vs 33 mg/L; P < .001), and lower platelet count (<150 ×103 cells/μL [212/523 {41%} vs 84/486 {17%}, P < .001]). A total of 398 patients (73.8%) with MIS-C and 253 (43.8%) with COVID-19 were admitted to the intensive care unit, and 10 (1.9%) with MIS-C and 8 (1.4%) with COVID-19 died during hospitalization. Among patients with MIS-C with reduced left ventricular systolic function (172/503, 34.2%) and coronary artery aneurysm (57/424, 13.4%), an estimated 91.0% (95% CI, 86.0%-94.7%) and 79.1% (95% CI, 67.1%-89.1%), respectively, normalized within 30 days. This case series of patients with MIS-C and with COVID-19 identified patterns of clinical presentation and organ system involvement. These patterns may help differentiate between MIS-C and COVID-19.

Dumbbell on the heart: two giant left coronary artery aneurysms in an adolescent.

Dumbbell on the heart: two giant left coronary artery aneurysms in an adolescent.

Kawasaki disease in Port Harcourt, Nigeria

Kawasaki disease (KD) is an acute febrile vasculitis of childhood, predominantly affecting medium-sized arteries with a predilection for coronary arteries and commonly occurring in children under the age of 5 years. Early recognition can be challenging; however, delayed diagnosis increases the risk of coronary artery abnormalities and death. We report a case of KD in a 19-month-old child who presented with prolonged fever, conjunctival congestion, skin rash and redness of lips and tongue. He was initially managed as a case of complicated measles, but with worsening symptoms, KD was suspected. Echocardiography revealed a left coronary artery aneurysm. He received two doses of intravenous immunoglobulin G, over a period of 24 h and responded remarkably to treatment. KD is rare in Port Harcourt, Nigeria, and children with prolonged fever and erythematous rash may be mistakenly managed for measles if there is no high level of suspicion amongst clinicians.

Giant calcified left coronary artery aneurysm

Case of 54 years old woman admitted to the ER for thoracic pain. The medical history of the patient is hypertension, dyslipidemia, angioedema (kiwi allergy), nephropathy (indeterminate), iatrogenic hepatitis and pulmonary nodule known from 20 years. Passive smoking and no alcohol. The family history revealed an hypertension in her father’s side.

Neonatal Kawasaki disease with multiple arterial aneurysms: a case report

BackgroundKawasaki disease (KD) is a medium vessel vasculitis that typically occurs in children aged between 6 months and 5 years. It is extraordinarily rare in the neonatal period. KD-related systemic artery aneurysms (SAAs) have never been reported in neonates.Case presentationA male infant was transferred to our institution for persistent high-grade fever lasting 16 days. Symptoms started at day 14 of life, and he was admitted to a children’s hospital on the second day of fever. Physical examination at the time found no signs suggestive of KD. The only laboratory parameters which were of significance were values suggestive of systemic inflammation. However, his fever persisted and inflammatory markers continued to rise despite 2 weeks of antibiotic therapy. KD as a noninfectious cause of fever was considered when he came to our institution, and echocardiographic findings of left and right medium coronary artery aneurysms (CAAs) confirmed our suspicions. Full-body magnetic resonance angiography also revealed bilateral axillary artery aneurysms. Administration of intravenous gamma globulin resulted in rapid improvement. His fever resolved on the next day and CAAs and SAAs regressed to normal at 6 months and 3 months after diagnosis, respectively.ConclusionThis unique case of incomplete KD highlights the importance of considering KD in neonates with unexplained prolonged fever and reinforces the need to remain vigilant for SAAs in KD.

Left Main Coronary Aneurysm: A Rare but a Serious Cause of Acute Myocardial Infarction

Left main coronary artery (LMCA) aneurysms are rare with incidence of 1 in 1000 cases among patients undergoing coronary angiography. Coronary artery aneurysm is defined as coronary arterial segment dilation > 1.5 fold greater than normal adjacent coronary segments. Atherosclerosis is the primary cause of coronary aneurysms but also has been reported in other conditions like arterial vasculitis (e.g., Kawasaki disease, Takayasu arteritis), or infection (e.g., syphilis, mycosis). LMCA aneurysms are especially associated with serious complications including thrombosis, distal embolization, spontaneous rupture or dissection or even sudden cardiac death. The optimal treatment for LMCA aneurysm is still controversial and the available results have been based mainly on case reports and not on controlled trials. The lack of consensus about managing LMCA is not the only challenge here. The lack of individualized treatment or precision medicine in this area makes managing these cases at bedside even more challenging.

Isolated Partially Thrombosed Aneurysm of the Left Main Coronary Artery in an Asymptomatic 60-Year- Old Cyclist

A 60-year-old asymptomatic male cyclist was referred for a screening computed coronary artery calcium scoring (CAC) prior to a week-long bike ride. He denied any chest pain or dyspnoea, and had no relevant personal medical or family history. He was a non–smoker. His CAC was 2,745 (99th percentile for age and sex). In view of the high CAC, we proceeded to perform a computed tomographic coronary angiography (CTCA), which demonstrated a giant calcific aneurysm of the distal left main coronary artery, measuring 18.5 × 15 × 18 mm partially filled with thrombus. The rest of the arteries were widely patent and showed no atherosclerosis. Extended vasculitis screen was negative and other causes of coronary aneurysm such as coronary trauma, percutaneous coronary angioplasty, Takayasu diseases, syphilis, Behçet disease, and neurofibromatosis were excluded. Kawasaki disease was proposed as the most probable cause. Cardiac magnetic resonance imaging demonstrated normal left ventricular size and systolic function and absence of scar. Adenosine perfusion magnetic resonance imaging showed no ischaemia. After a detailed discussion, the patient decided to carry on with his plans regarding the ride albeit with a reduction in effort given likely longevity and stability of the clinical condition. The optimal therapy for patients with isolated coronary artery aneurysm is not established with uncertainty about benefits of interventional/surgical treatment. Aneurysms of the left main coronary artery are rare clinical entities, encountered incidentally in approximately 0.1–0.3% of patients undergoing routine angiography. Kawasaki disease and atherosclerotic coronary artery disease are the common aetiologies.

Giant left coronary artery aneurysm with fistula to the right atrium diagnosed by echocardiography: a case report

Giant left coronary artery aneurysm with fistula to the right atrium diagnosed by echocardiography: a case report

Giant Aneurysm of Left Coronary Artery Associated With Aneurysm of Right Sinus of Valsalva

Giant Aneurysm of Left Coronary Artery Associated With Aneurysm of Right Sinus of Valsalva

Utility of post mortem MRI in definition of thrombus in aneurismatic coronary arteries due to incomplete Kawasaki Disease in infants

Abstract Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that primarily affects the coronary artery (CA) and presents in childhood. The characteristic coronary arterial lesion is an aneurysm, which may lead to thrombosis, dilatation, stenosis, and occlusion. Such an aneurysm is typically calcified and generally develops five or more years after the onset of acute KD. It becomes more noticeable after ten years. KD is sometimes difficult to diagnose because of the limited clinical features, especially in infants younger than 6 months old, where the clinical presentations often do not fulfill the diagnostic criteria for KD. We report a case of Incomplete Kawasaki Disease (IKD) causing unexpected death in infants. A seven-month-old male baby, apparently well nourished and without fever or exanthema that was unexpectedly found agonal in his bed by his parents. He died in an emergency room a few hours later in spite of aggressive resuscitation efforts. Postmortem Magnetic Resonance Images were obtained during the autopsy, with evidence of an occlusive thrombus in left and right coronary artery aneurysms. Laboratory findings were consistent with IKD. The crucial role of postmortem imaging is discussed here in order to improve diagnosis tools for preventable events.

Abstract 182: Proposal of Strategy for Threatened Rupture of Super-giant Coronary Aneurysm; Rare and Fatal Complication with Kawasaki disease

Background: Prognosis of Kawasaki disease and its main complications, coronary artery aneurysm (CAA) and myocardial ischemia were remarkably improved by intravenous immunoglobulin (IVIG) and other additional anti-inflammatory and anti-coagulation therapy. In contrast, rupture of coronary artery aneurysm is a rare, and still definitely fatal complication. Though approximately 10 cases were reported with sporadic occurrence in every three to four years in Japan, there is no patient whose life was saved. Case report: We experienced a 5-year-old boy who had already developed left CAA of 9 mm in diameter on the 7th day from onset of fever. Despite of repeated IVIG, left CAA was rapidly expanding day by day and finally the diameter became 18mm on the 12th day. Early in the next morning, sudden cardiac arrest was noted, but resuscitation was not effective. Autopsy revealed cardiac tamponade caused by rupture of very fragile wall of huge left CAA. Discussions: After this experience, we have tried to carry patients into the intensive care unit with deep sedation, if patient’s CAA is expanding more than 10mm within 2 weeks in acute stage of Kawasaki disease. Furthermore, we also recommend use of antihypertensive drugs such as calcium channel blocker and/or beta-blockers. We also have advised to colleagues in other hospitals to try in the same way when they asked for the management of similar cases. At least three patients with huge aneurysm were survived with this method in recent reports. If patient has strong inflammation sustaining with expanding huge aneurysm, plasma exchange and all possible anti-inflammatory agents including steroid or infliximab under the percutaneous cardiopulmonary support and surgeons' stand-by until inflammation will disappear. Following repair or platy of coronary aneurysm and coronary artery bypass surgery may be considered, but possibility and results are unknown. Conclusions: Because of its rarity, it is difficult to detect exact indication of deep sedation or intensive care, however, earlier and more cautious management will be safer for ‘super-giant’ aneurysm. Concerning to the sustaining inflammation with huge aneurysm, we would like to hear advices for this strategy from cardiac surgeons and pediatric intensivists.

Abstract 223: Surgical Resolution of Coronary Artery Obstruction in Incomplete Kawasaki Disease

Case Report 8 months old male, who presented with 7 days fever, hematuria, conjunctival injection and limb edema; treated as a post infectious glomerulonephritis. Twenty days later, desquamation at the tip of the fingers and in palms and soles plus thrombocytosis were found. Considering Kawasaki disease (KD), an echocardiogram was performed, finding a 5mm aneurysm in right coronary artery and 4mm ectasia in the left coronary artery. The patient was on the subacute therefore IVIG was not administered; aspirin however in antiplatelet dose range was begun. He continued on surveillance by Cardiology Department without signs of cardiac malfunction. At two years follow up a new echocardiogram was performed, showing a left coronary aneurism of 6mm and a right coronary artery of 2.0mm which was difficult to identify. Left ventricular function was preserved with an ejection fraction of 72%. Four years later, posterior myocardial necrosis, without acute ischemia on electrocardiography was found. A perfusion myocardial scan showed an uptake defect in apical region, both during stress and rest phase, suggesting an old apical infarction. Cardiac catheterization reported a tortuous right coronary artery with diffuse obstruction and left coronary artery aneurysm of 6.1mm. Due to findings above, heart transplant was considered. On a second perfusion scan a large perfusion defect on the inferior and septal wall, which improved during the rest phase was seen. The finding above correlates with inferior and septal myocardial infarction and residual ischemia. The PET-CT scan showed viable tissue in the left ventricle wall. Recently, the patient underwent revascularization surgery of right coronary artery with coronary artery bypass graft. Postsurgical echocardiogram reported a left coronary giant aneurysm of 8mm, ejection fraction of 40%, and a compromised posterior and inferior left ventricular wall function. We report the first case of surgical resolution of a coronary artery obstruction due to KD in our medical center. Because of patient’s age and coronary arteries abnormalities, a surgically intervention was the best approach in order to preserve patient’s life, cardiac function, improve the prognosis and mainly to gain time for future treatment decisions.

Abstract O.74: Statin Alleviates Persistent Coronary Arterial Inflammation Long After Kawasaki Disease - A Serial Fluorodeoxyglucose Positron Emission Tomography Study -

The patient, 42-year-old male, was suffered from Kawasaki disease (KD) at 4 month of age and left with giant left coronary artery aneurysm (CAA) and occluded giant right CAA. When he visited us at 40 years of age after long interval, a multi-detector X-ray computed tomography revealed persistent giant CAA with 12 mm in diameter at segment 6 with low density area inside of it, stenosis distal to this CAA, persistent giant CAA with 12 mm in diameter at segment 11, and total occlusion of right coronary artery orifice with recanalization. Positron emission tomography using fluorodexoy glucose (FDG-PET) with co-registration of x-ray computed tomography showed significant FDG uptake around the left coronary orifice of the aortic wall and extending to the proximal left CAA wall with 1.48 of target-to-background ratio, indicating persistent inflammation. He has 2 risk factors of atherosclerosis, dyslipidemia and a history of smoking and, since then he has been placed on 2 mg of oral pitavastatin. With the treatment, his LDL-cholesterol has decreased (105 at baseline vs. 74 mg/dL on treatment) though HDL-cholesterol did not change significantly (31 at baseline vs. 30 mg/dl on treatment). FDG-PET after 2 years of treatment indeed showed alleviation of coronary inflammation with significantly smaller area and lower uptake of FDG on the coronary wall with 1.28 of target-to-background ratio. This case indicates that statin can alleviate persistent coronary artery inflammation long after KD and FDG-PET can be a useful monitoring tool of this process.