Bilateral Giant Coronary Aneurysms Research Articles

Bilateral giant coronary aneurysms with cardiogenic shock

Bilateral giant coronary aneurysms with cardiogenic shock

Bilateral internal thoracic artery grafting in children under 5 years of age with Kawasaki disease: a case series.

BackgroundAlthough persistent coronary artery aneurysm of Kawasaki disease (KD) is rare, some patients develop a life-threatening myocardial infarction. In paediatric coronary artery bypass surgery (PCABS), the internal thoracic artery (ITA) graft is a reliable graft with favourable coronary outcomes. However, few studies have reported the outcomes and technical considerations of PCABS using bilateral ITAs in small children who have multivessel disease.Case summaryWe present the cases of three children under 5 years of age who underwent PCABS utilizing bilateral ITAs. All three patients had known bilateral giant coronary aneurysms associated with KD. Paediatric coronary artery bypass surgery was indicated after confirming multiple coronary lesions with myocardial ischaemia. One child underwent emergency PCABS because of circulatory collapse. The arterial anastomoses were performed under cardioplegic arrest. The left ITA was anastomosed to the left anterior descending artery (LAD) or the circumflex artery. The right ITA was anastomosed to the right coronary artery or the LAD. Post-operative coronary angiography revealed patent bilateral ITA grafts with an excellent run-off in all patients, and none of them have suffered any subsequent coronary event.DiscussionBilateral ITA grafting is a feasible procedure with favourable coronary outcomes for treating small children with multivessel disease, even in the setting of circulatory collapse.

Abstract 215: Fatal Arrhythmia In The Adult Patient Of Kawasaki Disease

We herein report the two adult patients hardly predictable sudden cardiac arrest caused by presumed Kawasaki disease (KD). Case 1: A 29- year-old man who had a history of KD at 10 months of his age complicated with bilateral giant coronary aneurysms, and was received a surgery of coronary artery bypass grafting (CABG) when he was 17 years old. He was transferred to emergency center because of sudden cardiac arrest during live concert and revived by automated external defibrillator (AED). Case 2: A 26-year-old man with a history of KD at 1year old of his age, complicated with bilateral giant coronary aneurysms, and was received a catheter intervention of rotational atherectomy (ROTA) to left anterior descending (LAD) artery at 16 years old of his age. He suddenly fell with ventricular fibrillation (VF) on playing futsal, and was hospitalized after revival by AED. Both of them had past history of myocardial infarction (MI) in their youths, however, did not have left ventricular dysfunction, symptomatic arrhythmia, and evidence of acute MI at admission. Therefore, it was difficult to strongly predict possibility of fatal arrhythmia in these cases. Finally, they received the second CABG’s for each after stabilizing and returned to their daily lives. It had been rarely reported a fatal arrhythmia in asymptomatic KD patients with normal left ventricular function with revival with recent spread of life support with public access of defibrillator. Our experiences may suggest one style with a paradigm shift in management of patients with coronary artery complications at the remote period of KD.

Abstract 203: Long-term Outcome Of Kawasaki Disease With Giant Coronary Aneurysms Which Waste Cardiac Follow-up; A Case Report

We report 2 cases of Kawasaki disease (KD) which required surgical interventions long after initial diagnosis. Case 1: Twenty-one years-old male. He was diagnosed as KD at the age of 1. Despite he received intravenous gamma-globulin therapy, bilateral giant coronary aneurysms were formed. In addition, multiple aneurysms include abdominal, iliac and axillary arteries were formed simultaneously. Coronary angiography (CAG) was thought to be dangerous because of iliac artery aneurysm formation. He received medical follow-up with aspirin administration only. He referred to our department at the age of 13. Ischemic changes were confirmed on both treadmill exercise test and cardiac scintigraphy. CAG showed 75% right coronary artery (RCA) stenosis and 99% left main trunk stenosis. Coronary artery bypass grafting (CABG) was performed and his postoperative course has been uneventful. Case 2: Thirty-seven years-old male. He was diagnosed as KD at the age of 1. Left giant coronary aneurysms were formed and subsequently aneurysm was occluded. Aspirin was administrated, but he interrupted medication and follow-up for himself. He referred to our institution due to cardiopulmonary arrest during exercise. After successful resuscitation, CAG revealed total occlusion of RCA and 99% left coronary artery stenosis. Emergent CABG was performed and no postoperative sequel has occurred. Both cases didn’t receive sufficient assessment during the follow-up period. As a result, fatal cardiac event was occurred in case 2. Coronary aneurysm tends to change into combine aneurysmal and stenotic lesion. Long time follow up is necessary even if patients have no symptom. In addition, to decrease lost follow up patients, we should explain the risk of sudden cardiac death repeatedly and emphasis necessity of long term follow-up and medication.

Bilateral giant coronary aneurysms in a 40-year-old male with Noonan syndrome caused by a KRAS germline mutation

We report a case of a 40-year-old man who was admitted to our hospital for the evaluation and treatment of chest discomfort on exertion. He had previously been followed for post-natal growth deficiency, strabismus, mental retardation, epilepsy, and moderate mitral regurgitation. On admission, he was 142 cm in height and 42 kg in weight. Physical examination revealed orbital hypertelorism, ptosis, a webbed neck, and low-set ears with no jugular vein dilatation or peripheral edema. Cardiac auscultation showed a 3/6 late systolic murmur and S4. ECG showed normal sinus rhythm, poor R wave progression in the precordial leads, and an incomplete right bundle brunch block. Chest X-ray showed pulmonary congestion and marked cardiomegaly, with a cardio-thoracic ratio of 71%.

A survey of the 3-decade outcome for patients with giant aneurysms caused by Kawasaki disease

Our purpose was to determine the outcome in patients with a more-than-20-year history of giant coronary aneurysms (GAs) caused by Kawasaki disease (KD). Between 2010 and 2011, the incidence and outcome of cardiac events (CEs) in patients with GA was surveyed by questionnaire by the Kinki area Society of KD research. Death, acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), percutaneous coronary catheter intervention, syncope, and ventricular tachycardia were considered as CEs. Survival rate and CE-free rate were analyzed by the Kaplan-Meier method. We enrolled 245 patients (187 were male, 58 were female), 141 with bilateral GA and 104 with unilateral GA. The interval between the onset of acute KD to the time of survey ranged from 0.2 to 51 years, and the median was 20 years. Death, AMI, and CABG occurred in 15 (6%), 57 (23%), and 90 patients (37%), respectively. The CE-free rate and the survival rate at 30 years after KD were 36% (95% CI 28-45) and 90% (95% CI 84-94), respectively. The 30-year survival rate for bilateral GA was 87% (95% CI 78-93), and for unilateral GA, it was 96% (95% CI 85-96; hazard ratio 4.60, 95% CI 1.27-29.4, P = .027). The 30-year survival rate in patients with AMI was 49% (95% CI 27-71), and the 25-year survival rate in patients undergoing CABG was 92% (95% CI 81-98). The outcome differed significantly between bilateral GA and unilateral GA. The results focus attention on the need to preserve myocardial perfusion, especially in high-risk patients with bilateral GA. An understanding of the optimal CABG would be useful in bilateral GA.

Progressive Left Coronary Stenosis After Rotablator Ablation Appreciated by Doppler Echocardiography

We describe a patient with a history of Kawasaki disease who showed coronary jet flow in the giant aneurysm on color-Doppler echocardiography caused by progressive coronary stenosis. A 6-year-old boy who had bilateral giant coronary aneurysms (14.9 mm in diameter) of the left main trunk (Fig. 1a) as sequelae of Kawasaki disease presented to us with anginal chest pain. Two years ago he had undergone coronary artery bypass graft surgery using the bilateral internal mammary artery grafted to the left anterior descending and left circumflex artery. Coronary angiography this time showed obstruction of both right and left internal mammary arteries. A color-Doppler echocardiography showed an aliased jet originating from the coronary ostium and flowing into the left giant coronary aneurysm with an early peak diastolic flow of 1.6 m/s (normal: 0.18– 0.3) with acute deceleration, being much faster than peak systolic flow velocity of 1.0 m/s (Fig. 1b). Because it was difficult to repeat the bypass graft surgery, he underwent successful rotablator ablation of the left coronary stenosis using 1.5-mm burr and the left coronary stenosis was significantly alleviated with a decreased peak diastolic flow velocity of 1.0 m/s (Fig. 1c) and temporary resolution of anginal chest pain. However, 2 months later, he complained of refractory chest pain again, with accelerated diastolic left coronary flow velocity of 2.0 m/s and underwent another attempt at rotablator ablation, but, unfortunately, he fell into shock during the procedure and could not be saved with multiple resuscitations. This case illustrates that color-Doppler echocardiography is a useful tool for evaluating coronary artery stenosis with a giant coronary aneurysm caused by Kawasaki disease and also emphasizes the difficulty of treating these small children with coronary stenosis [1, 2].

Bilateral giant coronary aneurysms diagnosed non-invasively by dynamic magnetic resonance imaging

Giant coronary aneurysms are sometimes misdiagnosed as cardiac tumors when they are filled with thrombus. In this case, dynamic magnetic resonance imaging revealed the coronary artery and cardiac mass, and was the most useful tool for diagnosis of giant coronary aneurysms non-invasively.