Pediatric coronary MR angiography with a two-minute scan using de-aliasing regularization based compressed sensing.

P138. Left Main Coronary Artery Aneurysms: Characteristics and Clinical Outcomes of a Rare Surgical Cohort

Giant aneurysm of the right coronary artery with the fistula to the coronary sinus and right atrium: long-term observation ended with a successful unconventional operation.

Refractory stent thrombosis in ST-segment elevation myocardial infarction with coronary artery aneurysm: successful sealing using a perfusion balloon.

‌Coronary inflammatory imaging and clinical factors: associations with coronary artery aneurysm regression in pediatric Kawasaki disease.

Giant left main coronary artery aneurysm with fistulous drainage to the right atrium: a rare case report and surgical management approach.

Christmas Lights on the Heart: A Rare Case of Multiple Giant Coronary Artery Aneurysms.

26-CCC-10444-ACC A CASE OF A RIGHT CORONARY ARTERY FISTULA TO THE GREAT CARDIAC VEIN WITH GIANT CORONARY ANEURYSM IN A 74 YEAR OLD

Abstract Kawasaki disease (KD) is a systemic vasculitis that requires prompt treatment to prevent coronary artery aneurysms and subsequent cardiac complications. This practice point presents guidance on the diagnosis and management of KD, including scenarios with severe disease and high risk for developing coronary artery aneurysms where subspecialty consultation is important.

Rationale:Kawasaki disease (KD) is an acute, self-limiting vasculitis that primarily affects infants and young children, and remains the leading cause of acquired heart disease in the pediatric population. With advancing disease course, adult survivors face a substantially elevated risk of developing secondary coronary artery abnormalities. When acute myocardial infarction (AMI) occurs in this population, outcomes are frequently poor due to the high prevalence of life-threatening complications, including malignant ventricular arrhythmias and cardiogenic shock.Patient concerns:Two young adult patients, aged approximately 30 years, presented with AMI complicated by cardiogenic shock, in the absence of conventional cardiovascular risk factors.Diagnoses:Coronary angiography demonstrated coronary artery aneurysms and multivessel coronary disease in both individuals. Given the lack of traditional cardiovascular risk factors, the AMI events were deemed secondary to long-standing coronary sequelae of antecedent KD.Interventions:Both patients were supported with venoarterial extracorporeal membrane oxygenation. This mechanical circulatory support successfully restored cardiac function and achieved hemodynamic stabilization during the acute critical phase of AMI and cardiogenic shock.Outcomes:Following venoarterial extracorporeal membrane oxygenation support, both patients achieved clinical recovery and were discharged home. However, during subsequent long-term follow-up, both individuals developed recurrent episodes of acute heart failure.Lessons:In patients with acute coronary syndrome attributable to KD-related coronary artery disease, prompt institution of mechanical circulatory support is critical when clinically indicated. This case further underscores that, even with successful acute-phase management, longitudinal follow-up and rigorous cardiac surveillance remain essential for early detection and prevention of progressive heart failure in this high-risk population.

Medium-to-giant coronary artery aneurysm (MGCAA) represents the most severe complication of Kawasaki disease (KD) and remains difficult to identify early. Existing risk scores are not tailored for MGCAA and lack external validation. Interpretable machine learning (ML) approaches may improve early risk stratification. We retrospectively analyzed 443 patients from Fuzhou (development cohort) and 2,334 from Suzhou (external validation). Multiple ML algorithms were compared, and a random forest (RF ranger) model was selected. Six routinely collected predictors were retained, and model interpretability was assessed using SHapley Additive exPlanations (SHAP). Discrimination, calibration, and decision curve analysis (DCA) were conducted. Intercept-only recalibration was applied for external adaptation. The final model included hemoglobin, time to diagnosis, oral mucosal changes, rash, triglycerides, and neutrophil percentage. The AUC was 0.70 in internal validation and 0.75 in external validation. Recalibration improved calibration-in-the-large. SHAP analysis supported the clinical interpretability of the selected predictors, and DCA indicated potential net benefit within a limited range of low-to-moderate threshold probabilities. The model is available as a web-based tool to support individualized risk estimation. This interpretable machine learning model enables early risk stratification for MGCAA using six routinely collected clinical variables, and may assist individualized clinical risk assessment in children with Kawasaki disease. Medium-to-giant coronary artery aneurysms (MGCAA) are the most severe cardiovascular complication of Kawasaki disease and are difficult to predict early, before imaging confirmation. This study proposes an interpretable machine-learning model for MGCAA risk assessment based on six routinely available clinical variables. The model incorporates SHAP-based transparency, external validation, and intercept-only recalibration to improve generalizability across populations. Deployed as a web-based tool, it facilitates individualized risk stratification and may support clinical decision-making related to monitoring intensity and follow-up strategies.

Kawasaki disease (KD) is an acute systemic vasculitis of childhood and the leading cause of acquired heart disease in children in developed countries. Infants frequently present with incomplete disease, resulting in delayed diagnosis and increased risk of coronary complications. Data on KD from Africa, particularly Ethiopia, remain extremely limited. This is the first reported case of incomplete KD in an Ethiopian infant. A fatal case of a six-month-old Ethiopian female infant with missed incomplete Kawasaki disease is reported. At four months of age, she presented with nine days of unexplained fever and markedly elevated inflammatory markers but lacked the classic clinical features of KD. The diagnosis was not considered and she was empirically treated for presumed infectious causes. Two months later she presented in cardiogenic shock. Echocardiography revealed giant coronary aneurysms with intraluminal thrombosis and severely depressed left ventricular systolic function. Despite intensive care support, the patient died within 12 hours of admission. This case highlights the devastating consequences of missed and delayed recognition of incomplete KD in young infants. Clinicians must maintain a high index of suspicion for KD in infants with prolonged unexplained fever and elevated inflammatory markers, even in the absence of classic clinical features. Strict adherence to established diagnostic algorithms is essential to prevent catastrophic cardiac complications, particularly in low-resource settings where awareness of KD remains limited.

This is a retrospective study to report our experience with a cohort of 50 patients with Kawasaki disease (KD) over 5 years. The study was conducted in the Department of Pediatrics. Data were retrieved from the medical records of patients admitted with KD collected from 2020 to 2024 and analyzed. Fifty children were included (male:female = 3.1:1; median age 2.6 years). Fever was universal, with a median duration of 7.5 days. Oral mucosal changes (68%) and rash (64%) were the most common clinical features. Coronary artery abnormalities (CAAs) were detected in 33 children (66%), comprising coronary dilatation (12.1%), small aneurysms (54.6%), medium aneurysms (24.2%), and giant aneurysms (9.1%). Left-sided coronary involvement, particularly of the left main and left anterior descending arteries, predominated and was associated with persistence of aneurysms on follow-up. Younger age and prolonged fever (>7 days) were significantly associated with CAAs (P < 0.05), while other classical clinical features showed no significant correlation. All patients received intravenous immunoglobulin and aspirin. Follow-up echocardiography was available in 72% of patients; 69.7% showed complete resolution of CAAs, while 30.3% had persistent but regressing aneurysms. No fatality or any long-term adverse effects were observed on follow-up. The disease needs to be considered as a differential diagnosis in an acute febrile illness in children persisting up to 5 days. Fever >7 days is significantly correlated with coronary abnormalities. Hence, early diagnosis is important to prevent morbidity.

This document presents a case report of a 74-year-old male patient admitted with three days of persistent chest pain accompanied by hemoptysis. Diagnostic imaging, including chest CT and coronary CT angiography, revealed pulmonary hemorrhagic lesions appearing as ground-glass opacities, predominantly located in the right lung, as well as a coronary artery aneurysm with surrounding thrombus in the circumflex artery. The case underscores the potential interplay between coronary vascular anomalies and pulmonary complications, emphasizing the value of advanced imaging techniques in diagnosis.

Echocardiography and computed tomographic angiography in a three-month-old boy confirmed a right coronary artery fistula and a right coronary artery aneurysm. The patient was successfully operated via right axillary thoracotomy approach.

BackgroundFamilial aggregation of stroke is well-documented, yet few studies have examined associations between stroke subtypes—particularly early-onset cryptogenic ischaemic stroke (eCIS)—and broader family history (FH) of cardiovascular disease. Such associations may provide insights into underlying etiologic mechanisms.MethodsIn this multicentre case–control study, we included eCIS patients aged 18–49 years and matched stroke-free controls. We analysed the association between FH of stroke, venous thromboembolism (VTE), coronary artery disease (CAD), aneurysms and eCIS using multivariable logistic regression, with a subgroup analysis stratifying patients by high-risk patent foramen ovale (HR-PFO).ResultsWe enrolled 508 eCIS patients (182 [36%] with HR-PFO) and 520 controls. Compared with controls, patients more frequently reported FH of stroke among first-degree relatives (FDR) (20% vs. 14%, P = .01) and grandparents (47% vs. 39%, P = .01), FH of early-onset stroke among FDR (5% vs. 2%, P = .01) and FH of early-onset VTE among FDR (5% vs. 2%, P = .003). In adjusted analyses, eCIS was associated with FH of stroke among FDR (OR 1.50; 95% CI, 1.04–2.16) and grandparents (1.50; 1.12–1.99), with FH of early-onset stroke among FDR (2.36; 1.11–5.04); and with FH of early-onset VTE among FDR (3.45; 1.47–8.13). eCIS was also associated with FH of VTE among FDR (1.80, 1.09–2.98) in the presence of HR-PFO. FH of CAD or aneurysms was not associated with eCIS.ConclusionFH of stroke and VTE, particularly early-onset events and in the presence of HR-PFO, are associated with eCIS. These findings support familial predisposition and highlight prothrombotic mechanisms in eCIS.Clinical trial registrationwww.clinicaltrials.gov/study/NCT01934725

Myocardial ischemia detected by SPECT/CT in patients with coronary artery aneurysm or ectasia. Insights from Coronary Artery Ectasia Database - Poland (CARED-POL).

The diagnosis of Incomplete Kawasaki disease (KD) is challenging. Approximately 20% of patients exhibit resistance to initial intravenous immunoglobulin (IVIG) therapy, termed IVIG-resistant KD, which is associated with a markedly increased risk of coronary artery aneurysms and long-term cardiovascular complications. We report a 4-month-old female infant who presented with 8 days of fever, bulging anterior fontanelle, elevated inflammatory markers, thrombocytosis, anemia, and leukocytosis. Echocardiography revealed left main coronary artery (LMCA) dilation (Z-score: 2.9), confirming incomplete KD with coronary involvement. Based on high-risk criteria augmented initial therapy with IVIG, prednisolone, and aspirin was initiated. Despite this, the fever persisted and coronary dilation progressed, confirming IVIG resistance. A second IVIG dose with intravenous methylprednisolone pulse therapy led to defervescence and echocardiographic improvement, with normalization of LMCA dimensions on follow-up. Early identification of high-risk incomplete KD, timely initiation of augmented therapy, and vigilant follow-up are critical in preventing coronary complications.

Giant right coronary artery aneurysm arising from a single coronary artery origin: A case report

Introduction: The existence of a coronary artery aneurysm (CAA) can pose significant risk for death. It can cause thrombosis, dissection, rupture or myocardial infarction. An exceedingly rare involvement of the left main coronary artery (LMCA), particularly giant-sized is even more catastrophic, a finding seen in only 0.1% of patients. Furthermore, co-existence with significant stenotic coronary artery disease (CAD) portends grim survival. Owing to the rarity of this combination, no data is available locally and only limited case reports are documented internationally. Hence, no consensus guidelines have been published yet. This paper aims to contribute to the sparse medical knowledge on the treatment approach and management of LMCA aneurysm with concomitant CAD. Case Presentation: A 62-year-old male, Filipino, hypertensive and hyperlipidemic sought consult due to one-year exertional chest pain. Coronary angiogram revealed the LMCA to be a diffusely aneurysmal, large-sized vessel measuring 9.7 mm x 7.9 mm with a significant two-vessel CAD affecting the proximal left anterior descending (LAD) and right coronary artery (RCA). As per multidisciplinary decision, the patient underwent surgical revascularization via cardiopulmonary bypass graft (CABG) addressing the CAD and LMCA aneurysm managed conservatively through guideline-directed medical therapy. The patient’s course of treatment was uneventful. He returned for follow-ups for three months post-surgery and remained symptom-free. Discussion: Giant coronary artery aneurysms (GCAA) are vessel dilatations that exceed 4x the diameter of a normal adjacent artery. The patient had a unique case of GCAA involving the LMCA combined with two-vessel CAD. Few studies have documented a medical or surgical approach and long-term outcomes are unknown. Without sufficient evidence-based guidelines, the multidisciplinary decision was to perform CABG and manage the LMCA aneurysm conservatively. Conclusion: Due to extremely limited information available on the giant LMCA aneurysm natural history, definitive management remains controversial. A multidisciplinary team approach is highly recommended for patient-specific needs to achieve favorable outcome and ensure survival. Keywords: Giant left main artery aneurysm, CABG, CAD