Giant Coronary Aneurysm Research Articles

Giant Coronary Aneurysm in a Patient with Systemic Lupus Erythematosus

Coronary aneurysm is rare in SLE and confirmation of etiology is usually made at postmortem examination. We encountered a giant aneurysm with multiple stenotic segments of the coronary arteries in a patient with SLE who had previous history of AAA/TAA. Resection of the aneurysm and coronary artery bypass graft were successfully performed. Histology of the coronary arterial wall showed severe damage of the media with inflammatory cell infiltration, indicating that the aneurysm was caused by arteritis. The aneurysm may have developed during the long course of inactive stage of SLE, emphasizing the need for screening of coronary lesions in the management of SLE.

Rapidly Evolving Giant Coronary Aneurysm

![Figure][1] Coronary artery aneurysms are relatively uncommon ([1,2][2]), and their treatment remains uncertain. This case illustrates dramatic progressive dilatation of a left anterior descending artery (LAD) aneurysm, treated with a covered stent. A 63-year-old male with a background

Preoperative and Postoperative Evaluation of Multiple Giant Coronary Aneurysms by the Use of Coronary CT Angiography with 64-MDCT: A Case of Multiple Giant Coronary Aneurysms Treated with Aneurysmectomy and Coronary Artery Bypass Surgery

A coronary artery aneurysm is an uncommon disorder and is seen as a characteristic dilatation of a localized portion of the coronary artery. Clinical manifestation of a coronary artery aneurysm varies from an asymptomatic presentation to sudden death of a patient. Although coronary aneurysms are typically diagnosed by the use of coronary angiography, a new generation of coronary 64-slice multidetector computed tomography (64-MDCT) scanners have successfully been used for evaluating this abnormality in a noninvasive manner. In the present case, we performed coronary 64-MDCT scanning preoperatively and postoperatively on a patient with multiple giant coronary aneurysms. The use of coronary 64-MDCT may provide an evaluation technique not only for diagnosis but also for follow-up after surgery for this condition.

EComment: Giant left coronary ostial aneurysm after modified Bentall procedure in a Marfan patient

We performed surgical repair of a giant left coronary ostial aneurysm after aortic root replacement using composite valve graft (modified Bentall procedure) in a patient with Marfan syndrome. Aneurysmal formation in the left main stem itself is very rare. In order to avoid mobilizing the coronary ostium from severe adhesions after previous surgery and to reduce the tension on the anastomosis, the left main trunk was reconstructed using an interposition Dacron graft. In aortic root surgeries in Marfan patients, the size of the side hole on the composite graft should be kept relatively small to fit the diameter of the native coronary arteries for prevention of coronary buttons from forming aneurysms at the level of the coronary button anastomosis. In addition, close observation to the coronary button anastomosis is indispensable in postoperative check-up.

Giant left coronary ostial aneurysm after modified Bentall procedure in a Marfan patient

We performed surgical repair of a giant left coronary ostial aneurysm after aortic root replacement using composite valve graft (modified Bentall procedure) in a patient with Marfan syndrome. Aneurysmal formation in the left main stem itself is very rare. In order to avoid mobilizing the coronary ostium from severe adhesions after previous surgery and to reduce the tension on the anastomosis, the left main trunk was reconstructed using an interposition Dacron graft. In aortic root surgeries in Marfan patients, the size of the side hole on the composite graft should be kept relatively small to fit the diameter of the native coronary arteries for prevention of coronary buttons from forming aneurysms at the level of the coronary button anastomosis. In addition, close observation to the coronary button anastomosis is indispensable in postoperative check-up.

Thrombus in a Coronary Artery Aneurysm Shortly After Warfarin Withdrawal

This report describes the rapid buildup of an intraluminal thrombus and secondary myocardial ischemia after a brief therapeutic withdrawal of warfarin in a case of Kawasaki-related chronic giant coronary aneurysm. The importance of tight antithrombotic control in such cases is underscored.

Giant Coronary Artery Aneurysm in the Left Main Coronary Artery: A Novel Surgical Procedure

Giant coronary artery aneurysm is quite rare and the corresponding surgical strategy is difficult to standardize. We present the case of a patient with giant coronary aneurysm involving the left main coronary artery who underwent an aneurysmectomy and coronary artery reconstruction with direct suture of the coronary vessels. Because of compression of the main pulmonary artery, the left main coronary artery was reconstructed using interposition of a short artificial graft.

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

Takayasu's arteritis is a chronic vasculitis of unknown cause. Coronary arteries are affected in approximately 10% of cases with aneurysm formation being extremely rare. Coronary aneurysms (not related to Takayasu's arteritis) have been surgically treated with aneurysm resection and coronary bypass. We describe the case of a young woman found to have giant coronary artery aneurysms. She underwent resection of the aneurysms and short segment saphenous vein bypass to the right and left coronary arteries. In reviewing the literature, this seems to be the first case of Takayasu's arteritis related to coronary artery aneurysm treated surgically with a good result.

Giant Coronary Artery Aneurysms in Kawasaki Disease—The Need for Coronary Artery Bypass

The incidence of coronary artery involvement has fallen markedly following early gammaglobulin infusions in Kawasaki disease. Nevertheless such involvement may still occur and if giant coronary aneurysms develop they are more likely to lead to myocardial ischaemia. Two subjects are described who developed giant aneurysms, one of whom was subjected to successful coronary artery bypass following the detection of myocardial ischaemia on a nuclear perfusion scan 5 years following his acute episode. The other is being followed to detect the first signs of any ischaemia. While all patients who develop coronary artery aneurysms following Kawasaki disease require diligent long-term review, that is especially important in the few with giant aneurysms. Early detection of significant coronary artery stenosis and its successful treatment may prevent myocardial infarction in childhood and adolescence with all its long-term consequences.

Giant coronary aneurysm caused by Kawasaki disease: follow-up with echocardiography and multidetector CT angiography

Giant coronary artery aneurysms caused by Kawasaki disease are not common; however, they are one of the most serious complications and can be fatal. Here, we describe a 5-year-old girl with Kawasaki disease who initially had normal coronary arteries. Despite intravenous immunoglobulin, she developed progressive giant coronary artery aneurysms. Echocardiography is a non-invasive tool for imaging the condition but it does have some limitations, whereas selective coronary angiography is the gold standard. However, multidetector CT may be a better non-invasive tool, alternate to invasive catheterized selective coronary angiography, in the long-term follow-up of patients with a giant coronary aneurysm.

Late giant coronary aneurysm associated with a fracture of sirolimus eluting stent: A case report

A 73-year-old female underwent percutaneous coronary intervention (PCI) because of stable angina. An elective PCI for the RCA lesion was first performed with deploying sirolimus eluting stents (SES). Three weeks later, PCI was also provided in the residual LAD lesion. Eight months later, she presented with new angina. CAG revealed an in-stent restenosis in the mid LAD and a large eccentric saccular coronary aneurysm (17 mm x 9 mm) at the proximal RCA. Intravascular ultrasound (IVUS) showed absence of stent struts around the orifice of aneurysm, which suggested a fracture of SES stent. The entry of coronary aneurysm was finally sealed with a polytetrafluoroethylene-covered stent. This report documented a rare case of late giant coronary artery aneurysm associated with a fracture of SES.

Giant Coronary Aneurysm in Kawasaki Disease

A 22-year-old man, occasional user of cocaine and smoker of 22 cigarettes/day, was referred to our center for chest pain. The physical examination and laboratory workup were normal. Electrocardiography showed right bundle branch block with Q-waves in V1, V2, and V3. The chest x-ray (Figure 1) revealed a round calcified image superimposed on the cardiac silhouette. On echocardiography, the left ventricle was found to be thinned and dilated, with general hypokinesia that was more evident in the septum and anterior aspect, and severe systolic dysfunction (ejection fraction, 30%). Coronary angiography showed complete occlusion of the left anterior descending artery distal to a giant calcified aneurysm (Figure 2) and complete occlusion of the right coronary artery. Dobutamine echocardiography Giant Coronary Aneurysm in Kawasaki Disease CARDIOLOGY IMAGE

Successful surgical treatment of a giant coronary aneurysm communicating with the right atrium

Aneurysms of the coronary arteries are rare events. In most cases, such abnormalities are clinically silent and, when they cause symptoms, there are dyspnea and/or angina. Our report describes a case presenting with dyspnea; the admission electrocardiogram demonstrated largely spread ischemia in the lower-lateral leads and myocardial necrosis in the inferior wall. Selective coronary angiography disclosed severe three-vessel disease; aortic angiography revealed a large vascular neoformation, partly thrombosed, with multilobes and a wide communication with the ascending aorta; the oxygen run showed a slight, non-significant 'jump' at the level of the right atrium, confirming a possible left-to-right shunt. On open chest surgery, these alterations were confirmed. The principal aneurysm (6-7 cm) originating in right auricle gave rise to a localized pseudoaneurysm above the superior vena cava; the other three aneurysmal structures were situated along the course of the right coronary artery. After 2 years of clinical and echocardiographic control, the patient is symptom-free under conventional medical treatment.

Warfarin Therapy for Giant Aneurysm Prevents Myocardial Infarction in Kawasaki Disease

We retrospectively investigated the effect of warfarin therapy in improving the clinical outcome of Kawasaki disease (KD) patients with giant coronary aneurysms (GAs). We followed 2350 KD patients from 1973 to 2004. The GAs (> or =8 mm in diameter) were diagnosed by coronary angiography. Sixty-eight patients (54 males and 14 females) were retrospectively studied. Patients were divided into two groups. One group consisted of 19 patients with 33 branches treated with a combination of low-dose aspirin and warfarin (target international normalized ratio: 1.5 - 2.5 IU). The second group consisted of 49 patients with 102 branches treated with low-dose aspirin without warfarin. The incidence of myocardial infarction was significantly less in the combination therapy group than in patients treated with aspirin without warfarin (1 patient vs. 16 patients, p < 0.05). Sudden death occurred in seven patients taking aspirin without warfarin, but none of the patients receiving warfarin died. No major bleeding events occurred in either group. Combination therapy of warfarin with aspirin is associated with a decreased risk of myocardial infarction in KD patients with GAs.

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

We report our approach to an unusual case of a 64-year-old man with multiple coronary artery aneurysms (CAAs) of the right, left anterior descending, and ramus coronary arteries. The right CAA was unusually large in size (measuring 5.5 cm). The aneurysms were obstructive, resulting in ischemic heart disease and heart failure. Multiple surgical techniques have been proposed to approach CAAs; however the ideal treatment strategy is poorly defined. This patient underwent successful revascularization using a combination of strategies, including aneurysm ligation, interposition reversed saphenous vein grafting, and bypass grafting. Surgical approach should be determined by aneurysm size, presence of branching vessels, and degree of stenosis.

Angiogenesis, tumor necrosis factor-α and procoagulant factors in coronary artery giant aneurysm of a fatal infantile Kawasaki disease

Kawasaki disease (KD) is an infantile febrile illness of unknown origin characterized by clinical, laboratory and histopathologic features of systemic vasculitis. We report a 3-month-old female infant with incomplete KD who suddenly died despite intravenous immunoglobulin, aspirin, steroid and heparin treatment. Postmortem examination confirmed the echocardiographically detected giant coronary aneurysms and showed occlusive thrombosis in the giant aneurysm of the left anterior descending coronary artery, associated with neoangiogenesis, macrophage infiltration and immunostaining for tissue factor (a strong initiator of the coagulation cascade), thrombopoietin receptor and tumour necrosis factor-alpha. These findings show the association of angiogenesis, tumor necrosis factor-alpha and procoagulant factors, with macrophage infiltration in coronary artery aneurysms of a fatal infantile KD.

Usefulness of Real-time 3-Dimensional Echocardiography for the Evaluation of Coronary Artery Morphology in Patients with Kawasaki Disease

This study was designed to evaluate the usefulness of real-time 3-dimensional echocardiography (RT-3DE) for evaluating coronary artery morphology in patients with Kawasaki disease. The diagnosis of coronary artery morphology in the acute phase of the disease is of prime importance for evaluating the likelihood of cardiovascular sequelae. Occasionally, visualization of the right coronary artery and bifurcated regions, including the circumflex artery, has proved challenging with traditional echocardiographic methods. A total of 111 patients with Kawasaki disease were studied. Coronary aneurysms were detected in 8 patients (4 had giant aneurysms), and coronary dilation was found in 11 patients. Coronary artery visualization was evaluated and scored as 1 of 4 grades, 0 to 3 points, for both 2-dimensional echocardiography (2DE) and RT-3DE. Evaluation criteria for each coronary artery were defined according to the American Heart Association classification of coronary angiographic features. Total scores for each patient and for individual coronary branches were compared between 2DE and RT-3DE. The total scores for coronary artery visualization were, respectively, showing a significantly higher score for RT-3DE than for 2DE (P < .01). A mural thrombus could be clearly delineated in the giant coronary aneurysms by RT-3DE. RT-3DE is superior to 2DE for coronary artery visualization. This diagnostic system is expected to improve the screening of coronary artery abnormalities in Kawasaki disease.

The Use of 2 Contrast Filling Patterns in the Diagnosis of a Giant Coronary Aneurysm

A 75-year-old woman was admitted for exertional dyspnea and chest pain that had been present for several months. She denied any past history of medical illness such as hypertension or diabetes, as well as any past history of significant trauma. On physical examination, no definite cardiac murmur was auscultated. A chest x-ray showed a bulging silhouette at the right border of the heart. Electrocardiographic findings showed no significant abnormalities. Two-dimensional echocardiography showed an abnormal echolucent large mass lesion at the right atrial side, suggesting an intraright atrial mass, pericardial cyst, or aneurysm. To determine the exact location of the mass and its relation to the right atrium, a contrast echocardiogram with intravenous agitated …

A giant coronary artery aneurysm presenting with cardiac tamponade

We report a case of giant coronary aneurysm presenting with cardiac tamponade, which was well documented with coronary angiography.

Coronary Artery Aneurysm Induced by Kawasaki Disease in Children Show Features Typical Senescence

Kawasaki disease (KD) causes coronary artery disease (CAD) in children. In addition, a history of KD is suspected to be a risk factor for the development of atherosclerotic heart disease in the future. Histological senescence changes are a common denominator in atherosclerotic lesions in adults, so the present study investigated whether histological senescence changes had already occurred in KD aneurysm. KD coronary aneurysms and internal mammary arteries retrieved from 5 children with KD (3, 4, 5, 6, and 11 years old, respectively) who underwent coronary artery bypass grafting, as well as giant coronary aneurysm size-reducing operations, were analyzed. Senescence-associated strong beta-galactosidase activity was observed in KD aneurysms, but not in the internal mammary arteries. An immunohistochemical analysis of the KD aneurysm using anti-CD31, anti-endothelial nitric oxide synthetase (eNOS), anti-vascular adhesion molecule-1 (VCAM-1), and anti-monocyte chemoattractant protein-1 (MCP-1) showed vascular endothelium CD31 staining, decreased staining of eNOS and strong staining of MCP-1 and VCAM-1. cDNA microarray gene expression profiling revealed increased MCP-1 expression in the KD aneurysm, a finding confirmed by quantitative polymerase chain reaction. Histological features of senescence and active remodeling gene expression show that the KD aneurysm is not a silent vasculitis terminal. The future fate of KD aneurysms, including atherosclerosis, should be monitored carefully.