Case Of Coronary Artery Aneurysm Research Articles

A Case of Coronary Artery Aneurysm Occurring After Drug-Coated Balloon Intervention for De Novo Chronic Total Occlusion

AbstractDrug-coated balloons (DCBs) have been proposed as a viable alternative to drug-eluting stents (DES) for managing chronic total occlusion (CTO), reducing adverse reactions associated with DES. However, adverse events after DCB treatment are rarely reported. We present a case of coronary artery aneurysm (CAA) formation after DCB treatment. A 55-year-old active smoker presented with exertional chest pain and positive ischemic response on the exercise stress test. Diagnostic coronary angiography revealed CTO in the mid-left anterior descending (mid-LAD) coronary artery with collateral circulation arising from the contralateral side. The patient underwent DCB treatment using a paclitaxel-coated balloon after predilatation with a noncutting balloon and a semi-compliant balloon. The final angiogram showed minimal recoil, type B coronary dissection nonflow limiting, and thrombolysis in myocardial infarction (TIMI) grade 3 flow. A follow-up coronary angiogram at 6 months revealed a fusiform aneurysm at the treated lesion with DCB. Despite the asymptomatic nature of the patient, good distal flow in the LAD, and the patient achieving a TIMI grade 3 flow, a decision was made to observe and closely monitor the patient. Despite potential risks, DCB remains a viable alternative to DES in CTO cases. Our case suggests that, although CAA occurred, it did not lead to significant adverse cardiac events. Further research is needed to understand the predictors and long-term outcomes of CAA.

A case report of cardiac rehabilitation in coronary artery aneurysm combined with acute ST segment elevation myocardial infarction.

Coronary artery aneurysm (CAA), marked by diffuse or localized dilation of artery, can cause life-threatening complications in acute coronary syndrome. This report presents a case of CAA combined with acute ST-segment elevation myocardial infarction, successfully treated with cardiac rehabilitation exercise therapy, offering insights for clinical practice.

Triple-Vessel Coronary Artery Aneurysms Following Drug-Eluting Stents

Coronary artery aneurysms (CAAs) after drug-eluting stents are rare. They can be found during routine angiograms when asymptomatic or present with acute coronary syndromes. We report a case of multiple CAAs who presented 8 years after the initial stenting. Left anterior descending artery was the culprit vessel and managed with restenting.

Giant left main coronary artery aneurysm

Introduction. Coronary artery aneurysms (CAAs) are rare disorders, especially the left main CAA. In the literature, there are several reported cases with CAAs, various localization, size, clinical presentation, and way of treatment. There is no unique consensus about the most adequate treatment for these patients; however, surgery is still preferable, although there are some new experiences of percutaneous treatment. The decision is made for each patient individually. We report a case of giant left main CAA, with acute coronary syndrome and heart failure presentation, surgically treated. Case report. A 66-year-old female patient was admitted to the emergency department of our clinic due to chest pain and dyspnea. Acute non-ST-elevation segment myocardial infarction (STEMI) of anterolateral localization was diagnosed (creatine kinase max 1,111 U/L, troponin T 3.754 ng/mL), complicated with acute heart failure. Heart catheterization and coronary angiography revealed a giant saccular, 3.5 ? 3.5 mm left main CAA full with thrombi, compressing the proximal segments of the left anterior descending and circumflex artery. Conclusion. Giant left main CAAs are rare pathologic findings, and there are no established principles for treatment. Although the percutaneous way of treatment is now available in selected cases, the surgical approach is still preferred for these patients.

A Case of Giant Right Coronary Artery Aneurysm after DES Implantation

Coronary artery aneurysms (CAAs) are not very uncommon but giant coronary artery aneurysms are rare with a reported prevalence of 0.02% to 0.2%. Recently, with the advent of implantation of drugeluting stents, there are increasing reports suggesting stents causing coronary aneurysms, months or years after the procedure. Though most of the CAAs are asymptomatic, they may present with various clinical presentations like angina pectoris, fistula formation, pericardial tamponade, compression of surrounding structures, congestive cardiac failure or sudden death. The natural history and prognosis remain unclear. Despite the important anatomical abnormality of the coronary artery, the treatment options of CAAs are still poorly defined and present a therapeutic challenge. We report a case of iatrogenic giant CAA following percutaneous transluminal coronary angioplasty (PTCA) with its relevant management strategy. Cardiovasc j 2022; 15(1): 88-94

A Rare Presentation of Coronary Aneurysm following Bare-metal Stent

We present a case of post-percutaneous transluminal coronary angioplasty with a bare-metal stent to the right coronary artery (RCA). He presented with acute ST-elevation inferior wall myocardial infarction. Coronary angiography showed an aneurysm of proximal RCA extending from the proximal end of the stent to the distal end. There was a 90% discrete lesion beyond the stent with TIMI III flow. The development of coronary artery aneurysms (CAAs) was reported even before the era of stents. CAA can develop after plain balloon angioplasty, after directional coronary atherectomy, and after bare-metal and drug-eluting stents also but not after coronary angiography. Kachru et al. reported an incidence of 0.2% (4 of 2408) per DES without routine angiographic follow-up and Rha et al. reported an incidence of 1.7% (five out of 296) per patient at 6-month routine angiographic follow-up. CAA is an uncommon and often accidental finding, we report a case of CAA which presented as acute myocardial infarction mimicking stent thrombosis.

Clinical case of coronary artery aneurysm

An aneurysm of a coronary artery is considered to be its expansion by 1.5 times or more over a short distance. The relevance of this pathology is determined by the severity of complications, mainly thrombotic. According to autopsies, it is detected in approximately 1.5% of all autopsies. In the majority of cases, coronary artery aneurysms are asymptomatic, but they also can cause symptoms similar to acute coronary syndrome. A rupture of the aneurysm is a rare but potentially dangerous complication of coronary artery aneurysm. The tactics of managing patients is determined by the severity of symptoms, aneurysm localization, the dynamics of the aneurysm, the presence of myocardial infarction in the area of the altered artery blood supply, the risk of surgical intervention, the distribution and degree of atherosclerotic changes in the coronary vessels, and the possibilities of drug therapy. Reliable diagnostic methods are coronary angiography and multidetector computed tomography. The paper describes a clinical case with patient G., aged 50, who was admitted to the emergency cardiology department with a typical picture of acute coronary syndrome, with stable hemodynamics and without echocardiographic signs of ischemia or infarction. An in-depth study of the coronary system was carried out in order to determine the prospects and the need for planned percutaneous coronary intervention. Computed tomography was performed for this purpose and revealed not only high degrees of stenosis in several coronary arteries, but also structural changes in the coronary system in the form of an aneurysm of the proximal segment of the anterior interventricular branch. The results obtained with computed tomography determined the need for coronary angiography. Its data made it possible to clarify the number, location and severity of stenotic changes in the coronary arteries, as well as to determine other localizations of aneurysms of the coronary system. The summary data of the two studies made it possible to establish that the patient had both stenosing atherosclerosis of the coronary arteries and multiple aneurysms of some arteries at the same time. It was deemed appropriate to continue conservative treatment aimed at preventing recurrence of acute coronary syndrome and thrombosis of coronary artery aneurysm, treatment of hypertension and secondary prevention of atherosclerosis. This clinical case demonstrates that the combined pathology of the coronary arteries can have clinical manifestations in the form of a single episode of acute coronary syndrome.

Safety of warfarin therapy in children with coronary aneurysm due to Kawasaki disease

Objective: To investigate the safety of warfarin for Kawasaki disease (KD) with coronary artery aneurysm (CAA) and its prognosis. Methods: Twenty one children with KD complicated with giant CAA, multiple CAA in one coronary artery or thrombosis in coronary artery were enrolled in this prospective study. Warfarin was used to control the goal international normalized ratio (INR) ranging from 2.0 to 3.0. The CAA diameter, number, location and thrombus in coronary artery were recorded at the beginning of treatment, 1, 2, 3, 4 weeks and 2, 3, 6, 12 months after treatment, as well as the influence on INR, electrocaroliogram, creatine kinase-MB (CK-MB), troponin I. Standardized warfarin bleeding risk training and management was implemented. Children were divided into implementation group and non-implementation group according to the status of actual implementation of their parents. The incidence of bleeding events was compared between the two groups. Comparisons between groups were performed using a Rank sum test and a Fisher exact test. Results: In the 21 patients (15 males and 6 females), the age of onset ranged from 2 months to 6 years. There were 4 cases with grade Ⅱ, 7 cases with grade Ⅲ, 7 cases with grade Ⅳ and 3 cases with grade Ⅴ according to the severity of coronary arterial lesions before treatment. The time of clinical detection of thrombus in 10 children with thrombosis ranged from the fourth day to the fourth month. The dose distribution of warfarin was 0.06-0.10 mg/(kg·d), and the INR was 1.80-2.59. Among the 10 cases with thrombus, 8 cases had disappearance of thrombi and 2 cases with grade Ⅴ had thrombus organization to different degree. After treatment, the coronary artery ectasia of the 4 cases with grade Ⅱ all returned to normal. Among the 7 cases with grade Ⅲ, 3 cases of coronary artery aneurysms returned to normal, and 4 cases did not change. Among the 7 cases with grade Ⅳ , 5 cases of coronary artery aneurysms shrank to grade Ⅲ, and 2 cases remained unchanged. Three cases with grade Ⅴ lesions had no changes in aneurysm. Neither new thrombus nor new CAA was detected during the treatment. There was no significant change in electrocardiogram before and after treatment. No statistically significant difference was found regarding the troponin I (0.07 (0-3.01) vs. 0.04 (0-0.29) μg/L, Z=0.932, P>0.05) and CK-MB (20.6 (11.2-58.2) vs. 29.0 (16.7-47.0) U/L, Z=1.906, P>0.05) before and after treatment. The incidence of bleeding events in the implementation group was significantly lower than that in the non-implementation group (2/15 vs. 4/6, Fisher=5.689, P=0.031). Conclusions: The application of goal INR of 2.0-3.0 and adjustment of warfarin dose according to the severity of CAA combined with standardized and strict warfarin bleeding risk training and management, can increase the safety of warfarin therapy in children with KD, improve the prognosis of coronary artery lesions, promote the dissolution of thrombi, prevent new thrombosis, and effectively reduce the incidence of bleeding complication.

Determination of the Relationship Between Kobayashi, Sano, and Egami Criteria and Prevalence of Intravenous Immunoglobulin Resistance and Coronary Artery Aneurysm in Iranian Children with Kawasaki Disease.

IntroductionKawasaki disease (KD) is a systemic vasculitis that occurs mostly in children under five years old. Kawasaki affects the middle-size arteries, especially the coronary arteries. Therefore, without adequate treatment, it may cause coronary artery aneurysm in 25% of patients. The purpose of this study was to investigate the relationship between Kobayashi, Sano, and Egami criterions with coronary artery aneurysm in KD patients during the last ten years and to identify risk factors in patients with intravenous immunoglobulin (IVIG)-resistant and coronary artery aneurysms.MethodologyMedical records of 363 Kawasaki patients referred during 2008–2017 were reviewed. Patients’ demographic data and Kobayashi, Sano, and Egami scores of each patient were calculated. Based on echocardiographic findings, cases of coronary artery aneurysm were determined. Sensitivity, specificity, positive and negative predictive value, and the accuracy of each criterion were determined to predicting IVIG resistance and detect coronary artery aneurysm.ResultsThere was a slight relationship between IVIG-resistance in Kawasaki children and its prediction based on the Kobayashi risk score, but no relationship was found between the Egami and Sano criteria. Sixty-three patients (17.4%) had coronary artery lesions (CALs) on time of diagnosis. There were no statistically significant differences between gender and mean age of children with and without CALs. Also, there was no significant relationship between coronary artery aneurysm in Kawasaki children and its prediction based on the above three risk factors. The area under the ROC-curve of all three risk measures of Kobayashi, Egami, and Sano indicated that all three criteria were not useful in predicting CALs.ConclusionDespite the low accuracy of the three above criteria to predictive of patients with IVIG resistance, it seems that the variables of age, duration of fever, and C-reactive protein (CRP) are more useful than other variables and may be utilized to evaluate patients by establishing a more appropriate cut-off point.

P258 Giant coronary arteriovenous fistula with significant left-to-right shunt in symptomatic patient - a multimodal diagnostic approach and successful surgical treatment

Abstract Funding Acknowledgements none OnBehalf none Coronary arteriovenous fistula (CAF) is a rare usually congenital defect that occurs in 0.1-0.2% of patients undergoing coronary angiography. A left-to-right shunt exists in more than 90% cases. In approximately 20% of patients CAF is accompanied with coronary artery aneurysm (CAA). We describe a case of 65-years-old woman with history of murmur from childhood, who presents with symptoms of slowly worsening dyspnea on exertion and strong pericardial pain. A suspicion for CAF was made from echocardiography and finally confirmed by other diagnostic modalities (coronary angiography and computed tomography with 3D reconstructions). We have diagnosed a complex case of a giant CAA involving left main and a periphery of left circumflex artery, accompanied with CAF terminating in the right atrium, responsible for a significant left-to-right shunt and coronary steal phenomenon. Patient was successfully treated by surgical ligation of the distal part of CAF in the right atrium. There were no signs of an acute myocardial ischemia on beating heart (ECG, perioperative echocardiography) when CAF was temporary occluded by tourniquet and so definitive surgical ligation of CAF was performed back on cardiopulmonary bypass. The postoperative course was uneventful without complications and the patient was discharged 6 days after surgery. One year after surgery patient is doing well with no complaints. Control echocardiography showed a regression of left and right ventricle volume overload. Coronary angiography showed normal perfusion in the left coronary artery territory, and no more visible collaterals flow right coronary artery. Abstract P258 Figure. complex coronary artery aneurysm

Analysis on high risk factors for early coronary artery aneurysms early complicated with Kawasaki disease in inpatients by single-center analysis for 6 years

Objective To investigate the high risk factors for early coronary artery aneurysms(CAA)early complicated with Kawasaki disease (KD) in inpatient children. Methods Totally 679 inpatient children with KD from January 2005 to December 2011 in Children′s Hospital of Chongqing Medical University were enrolled in this study.These data were analyzed by Chi-square test to analyze the possible risk factors for CAA.Multiple Logistic regression analysis was performed to estimate the OR and 95%CI for the risk factors. Results There were 385(56.70%) male and 294(43.30%) female cases with the onset ages of 2 months to 15 years and 7 months.There were 32 cases (4.71%) of CAA, among them, 8 cases resistant to intravenous immunoglobulin (IVIG). In total 32 cases of CAA, 25 cases were treated with 2 g/(kg·time) IVIG for 1 to 3 times, and 2 cases were also treated by methylprednisolone.The other 7 cases of CAA were treated with IVIG less than or equal to 1 g/(kg·time) for 4 to 7 times.There were 6 recu-rrent KD cases (0.88%), occurred on the 2nd-18th month after the onset of the illness, including 1 case complicated with CAA.There was no death case during the acute stage.The monofactor analysis showed that male, duration of fever ≥ 10 d, time of treatment with IVIG ≥7 d, hemoglobin 0.05). The multiple Logistic regression analysis showed that hemoglobin <100 g/L (OR=2.99, 95%CI: 1.01-8.75, P=0.04), duration of fever ≥ 10 d (OR=6.67, 95%CI: 1.57-22.54, P=0.01), time of treatment with IVIG ≥7 d(OR=3.57, 95%CI: 1.12-11.02, P=0.02) were the independent risk factors for CAA. Conclusions The levels of hemoglobin<100 g/L, duration of fever ≥ 10 d and time of treatment of IVIG ≥7 d are the independent risk factors for CAA. Key words: Kawasaki disease; Coronary artery aneurysms; Risk factor

Coronary artery aneurysms following drug eluting stents implantation: A retrospective analysis from series of cases at tertiary care cardiac centre over three years

Background: Inflammation and healing after vascular injury during the procedure and other factors may be theoretically associated with a risk of coronary artery aneurysm (CAA) formation after drug eluting stent (DES) implantation. Very few studies have provided the epidemiological features and proposed causative factors of CAAs after DES implantation. Aims and Objectives: We aim to retrospectively study the incidence, morphological features and proposed causative factors of coronary artery aneurysms noted after drug eluting stent implantation at a tertiary care cardiac centre over period of three years (2015-2018). Methods: All cases of coronary artery aneurysms occurring after drug eluting stent implantation over a period of three years (2015-2018) were studied retrospectively. Incidence, morphological and clinical features of aneurysms were retrospectively analysed from case records and angiographic analysis from computerized database at our tertiary care cardiac centre. Results: Over period of three years (2015-2018) seven cases (Incidence-0.52%) of coronary artery aneurysms were noted after DES implantation with 1340 coronary angioplasty and stenting procedures done during this period for any indication. Association of diabetes and and high pressure post dilation was seen in five (71.4%) cases. A male sex and Left anterior descending artery predilection was noted and all incriminated stents were durable polymer stents. Dissection during predilatation of the lesion was seen in two (28.5%) patients. Conclusions: Coronary artery aneurysms associated with DES implantation are rare in the current era of biodegradable polymer stents. Various procedure and stent related factors are involved in its causation.

Coronary Artery Aneurysm after Second-Generation Drug-Eluting Stent Implantation.

PurposeWe evaluated the incidence, predictors, and prognosis of coronary artery aneurysm (CAA) after second-generation drug-eluting stent (DES) implantation.Materials and MethodsA total of 976 consecutive patients (1245 lesions) who underwent follow-up angiography after second-generation DES implantation were analyzed. Incidence and predictors of CAA were assessed, and clinical prognosis was compared with 34 cases of CAA after first-generation DES implantation using previous CAA registry data.ResultsAll 10 cases of CAA (0.80% per lesion) in 10 patients (1.02% per patient) were detected at follow up. Compared to lesions without CAA, those with CAA had greater involvement of the proximal segment (90% vs. 51%, p=0.014), a higher proportion of pre-intervention, a Thrombolysis in Myocardial Infarction score of 0 or 1 flow (80% vs. 16%, p<0.001), more chronic total occlusions (40% vs. 10%, p<0.001), and longer implanted stents (41.9±23.2 mm vs. 28.8±14.8 mm, p=0.006). As for CAA morphology, instances of CAA after second-generation DES were predominantly the single fusiform type (90%), whereas instances of CAA after first-generation DES were multiple saccular (47%) and single saccular (35%) types (p<0.001). Myocardial infarction with stent thrombosis occurred in 5 patients with CAA after first-generation DES (15%), and no adverse events were observed in patients with CAA after second-generation DES over a median follow-up duration of 4.3 years (p=0.047, log-rank).ConclusionAlthough CAAs after second-generation DES implantation were detected at a similar incidence to that for CAAs after first-generation DES implantation, second-generation DES-related CAAs had different morphologies and more benign clinical outcomes versus first-generation DES-related CAAs.

Unusual case of coronary artery aneurysms after drug eluting stent implantation in two vessels presenting as acute pericarditis

Unusual case of coronary artery aneurysms after drug eluting stent implantation in two vessels presenting as acute pericarditis

A case of coronary artery aneurysm after sirolimus-eluting stent implantation presenting with unstable angina due to progression of stent thrombosis: Concerns over sirolimus-eluting stents remain

A 44-year-old man was implanted with a sirolimus-eluting stent in the proximal left anterior descending artery 8 years previously. Six years later, multi-slice computed tomography and angiography confirmed the formation of a coronary artery aneurysm around the stent. Optical coherence tomography revealed organized thrombi within the stent. Eight years after implantation, the patient presented with chest pain, and multiple imaging modalities revealed thrombotic occlusion within the stent. Surprisingly, the coronary artery aneurysm became a detour for distal flow from the occluded stent. Long-term follow-up after implantation of first-generation drug-eluting stents is mandatory, because unexpected reactions can suddenly occur.<Learning objective: The present case experienced two episodes of unstable angina in very late stage after sirolimus-eluting stent implantation. In addition to the chronic inflammatory reactions and progressive positive remodeling, turbulent and sluggish blood flow within the aneurysm may have resulted in the stagnation of coronary flow, leading to multiple episodes of very late stent thrombosis. Careful and long-term follow-up using multiple imaging modalities should be mandatory after the first drug-eluting stent implantation.>

Rare coronary artery reactions after implantation of drug eluting stents

. Coronary artery aneurysms (CAA) after coronary intervention are rare, with a reported incidence of 0.3% to 6.0%, and the most “aneurysms” are in fact pseudoaneurysms. Drugeluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth, thereby suppressing restenosis, but at the same time potentially causing coronary aneurysms. In this presentation our goal is to discuss our already published case of stent fracture and one case of CAA after implantation of DES. First case is a 62-year-old female who was admitted for cardiac catheterization due to positive stress test consistent with anteroseptal ischemia. One year earlier she had undergone percutaneous coronary intervention (PCI) with placement of two sirolimus eluting stents to left anterior descent artery. Coronary angiography showing complete stent fracture in the mid-LAD with lateral dislocation of distal fragment, significant focal in-stent restenosis and saccular coronary aneurysm below the fracture level. We decided to place graft stent covering the site of the stent fracture and in-stent restenosis. After the procedure coronary artery aneurysm was completely excluded. Second case is a 70-year-old female who had gone to PCI due to acute myocardial infarction of anterior wall. Everolimus eluting stent (EES) was implanted in LAD. Another EES was implanted in right coronary artery (RCA) due to suboclusion. Six months after patient was admitted because of reinfarction in anterior wall. Coronary angiography was performed showing two large CAA of LAD (bifurcation LAD/ first diagonal) and RCA at the site of previously implanted EES and thrombotic occlusion of LAD at the distal portion of EES. Intervention was performed with implantation of bare metal stent distally to EES in LAD. Patient is scheduled for next intervention with intention to exclude aneurysm of RCA with implantation of graft stent and coil embolization to LAD. In conclusion coronary interventions are valid treatment options, but further investigation is necessary to determine natural history, and best therapies for DES-associated CAA and stent fractures. Tomislav Krcmar 1*

EComment. Coronary artery dilatation: ectasia or aneurysm

We read with great interest the paper by Singh et al [1]. They described surgical treatment including proximal ligation and plication of the aneurysm with coronary artery bypass grafting in a series of 4 cases of coronary artery aneurysm (CAA) from a single centre. We would like to congratulate the authors for bringing such a rare entity to our attention. We would also like to add a short comment on this topic. Coronary artery dilatation is an exceptional and frequently unrecognized incidental finding in patients with coronary artery disease [2]. At present there is no uniform definition of this pathology. Coronary artery ectasia (CAE) and CAA are characterized by an abnormal dilatation of the coronary artery. They are used interchangeably for the condition. CAE may be classified into four types on basis of the extent of coronary artery involvement: Type I - diffuse ectasia of two or three vessels; Type II - diffuse ectasia in one vessel and localised disease (ie, aneurysm) in another; Type III - diffuse ectasia in one vessel only, and; Type IV - localised or segmental involvement (CAA) only [3]. This classification may have prognostic implications, with the worst outcomes in types I and II [2]. CAA may be classified in three different ways on the basis of the composition of the vessel wall (true aneurysms or pseudoaneurysms), the morphologic structure (saccular or fusiform aneurysms), and size (e.g., large or giant aneurysms) [2]. The various factors contributing to CAA formation include atherosclerosis, congenital malformations, Kawasaki disease, percutaneous coronary interventions, inflammatory arterial diseases (polyarteritis nodosa, systemic lupus erythematosus, Takayasu's arteritis), infectious causes (endocarditis, syphilis, candidosis, Lyme borreliosis), chest traumas, vasculitis (eg, Behcet disease), connective tissue disorders (Marfan's syndrome, Ehlers Danlos syndrome, scleroderma), primary cardiac lymphoma and primary hyperaldosteronism [2]. CAE is used to describe diffuse dilatation (>1.5 times the normal diameter) of the coronary arteries that involves 50% or more of the length of the vessel. However, CAA is defined as a localized dilatation that exceeds the diameter of normal adjacent coronary artery segments, or the diameter of the patient's largest coronary vessel by 1.5 times. Herein, coronary artery involment is less than 50% of the total length of the vessel [2]. A giant aneurysm is defined as one where the maximal vessel diameter exceeds 20 mm in adults or 8 mm in children. In adults, the reported diameter of giant CAAs varies from 50 to 150 mm. Giant CAAs are rare, with a reported prevalence of 0.02% [4]. Potential complications include rupture (subsequent cardiac tamponade), thrombosis, embolization, dissection, mechanical obstruction, and erosion into surrounding structures. In these patients, surgery should be considered as a means to avoid complications [5]. Conflict of interest: none declared

Surgical treatment for coronary artery aneurysm: a single-centre experience

Coronary artery aneurysm is a rare condition with a reported incidence of 0.14-4.9% in patients undergoing coronary angiography and 0.3-5.3% in patients after percutaneous transluminal coronary angioplasty (PTCA). Optimum surgical therapy for this entity is difficult to standardize. We present here a series of 4 cases with the aim of establishing an optimal surgical therapy for this rare entity. Four cases of coronary artery aneurysm were admitted in the Department of Cardiology and Department of Cardiothoracic and Vascular Surgery, King George's Medical University, Lucknow, from April 2010 to April 2012. All patients underwent a surgical procedure that involved ligation and plication of the aneurysm with coronary artery bypass grafting. Out of the four coronary artery aneurysm patients, 1 was atherosclerotic and the remaining 3 patients developed coronary artery aneurysm after PTCA with a drug eluting stent to the left anterior descending artery. After surgery, all patients recovered uneventfully without any recurrence of symptoms in the follow-up. Coronary artery aneurysm is a rare entity and is being seen more frequently with the increasing use of stents during PTCA. Proximal ligation and plication of the aneurysm with coronary artery bypass grafting in the present series provided good results. With this case series, we seek to establish an optimal surgical therapy for this rare entity.

An unusual location and causation of coronary artery aneurysm and its surgical treatment—A case report

The most common causes of coronary artery aneurysm are atherosclerosis and Kawasaki disease. The disorder is frequently associated with severe multivessel atherosclerotic disease. If the aneurysm is associated with significant coronary artery disease and is leading recurrent ischemia, surgery should be considered. However, the surgery to be performed is not well established and largely depends on the shape of the aneurysm and the preference of the surgeon. We report a case of coronary artery aneurysm due to poststenotic dilation, located at the bifurcation point of the left anterior descending artery and the circumflex artery treated surgically.

Coronary artery aneurysm and thrombosis following chronic ephedra use

Ephedra, also known as Ma Huang, was commonly used to enhance athletic performance, “fat burning", and weight loss before its removal from the United States in April 2004 due to acute adverse health reactions including lethal arrhythmias, stroke, vasoconstriction, and myocardial infarction. We report the case of a 29-year-old patient with acute myocardial infarction, secondary to coronary artery aneurysms and thrombosis who reported use of Ma Huang, Xenadrine(r)RFA, and Hydroxycut at recommended dosages for a combined total of approximately 2 years. Other causes of coronary artery aneurysm and hypercoagulability were ruled out. Our case exemplifies the long-term (as opposed to acute) danger of ephedrine products and the first case of coronary artery aneurysm associated with its use.