Giant Coronary Aneurysm Research Articles

Multiple Giant Coronary Aneurysms Arising from Coronary Fistula to the Pulmonary Artery Revealed in Aorta CT Angiography

Multiple Giant Coronary Aneurysms Arising from Coronary Fistula to the Pulmonary Artery Revealed in Aorta CT Angiography

Giant coronary artery aneurysms involving all three coronary arteries

Coronary artery aneurysm is defined as any coronary artery dilation exceeding the diameter of normal adjacent segments or the diameter of the largest coronary artery by 1.5 times. Giant coronary aneurysm refers to an aneurysm with a diameter larger than 20 mm. Giant coronary artery aneurysms have an incidence of 0.02%–2%. Here we describe a patient who had giant coronary aneurysms involving all three coronary arteries. He was managed conservatively with no cardiac events on a follow up of 1 year.

Giant coronary aneurysm and arterial tortuosity.

Giant coronary artery aneurysm is rare. A 71-year-old female was referred to our hospital 3 months after onset of symptoms. Work-up including coronary angiogram and computed tomographic angiogram helped a definite diagnosis of a giant aneurysm of the circumflex coronary artery. The patient was conservatively managed with a close follow-up. In this article, this rare lesion was presented with associated anomalies.

Effect of pravastatin on endothelial dysfunction in children with medium to giant coronary aneurysms due to Kawasaki disease.

Ongoing low-grade inflammation and endothelial dysfunction persist in children with coronary lesions diagnosed with Kawasaki disease (KD). Statins, frequently used in the management of high cholesterol, have also shown to improve surrogate markers of inflammation and endothelial dysfunction. This study was undertaken to investigate the efficacy and safety of pravastatin in children with coronary artery aneurysms due to KD. The study enrolled 14 healthy children and 13 male children, aged 2-10 years, with medium-to-giant coronary aneurysms for at least 12 months after the onset of KD. Pravastatin was given orally to the KD group at a dose of 5 mg/day for children under 5 and 10 mg/day for children older than 5 years. To determine the effects of pravastatin on endothelial function, high-frequency ultrasound was performed before the start of the study and 6 months after pravastatin therapy. The parameters measured were brachial artery flow-mediated dilation (FMD), non-flow mediated dilation (NMD), and carotid artery stiffness index (SI). High sensitive C-reactive protein (hs-CRP) levels, the circulating endothelial progenitor cells (EPCs) number, and serum lipid profiles were also determined at baseline and after 6 months of pravastatin treatment. Before treatment, the KD group had significantly decreased FMD (P<0.05) and increased SI and hs-CRP levels (P<0.05) compared with controls. After 6 months of pravastatin therapy, FMD improved significantly compared to the baseline KD group (3.16±6.49 to 10.05±7.74, P<0.05), but remained significantly less than that in the control group with no significant changes in NMD and SI. There were significant decreases in markers of inflammation after treatment. The hs-CRP levels decreased significantly from 2.93±0.81 mmol/L to 2.14±0.82 mmol/L (P<0.05) and the serum apo-B and apo-B/apo-A1 ratio were also reduced (P<0.05) in the KD group. However, the circulating EPC number was not significantly different between baseline and that following pravastatin treatment in the KD group and the control group (P>0.05). No significant complications were noted with paravastatin therapy. Pravastatin improves endothelial function and reduces low-grade chronic inflammation in patients with coronary aneurysms due to KD. Children with coronary aneurysms due to KD may benefit from statin therapy.

360 Degrees Out of Trouble: A Novel Wiring Technique Required in Management of Acute Occlusion of a Giant Coronary Aneurysm

Giant coronary aneurysms in adults are rare [(1)][1]. We describe the novel management of acute myocardial infarction caused by thrombotic occlusion of a proximal circumflex giant coronary aneurysm. A 360° loop of balloon/guidewire assembly within the aneurysm was required for successful

Guidelines for medical treatment of acute Kawasaki disease: report of the Research Committee of the Japanese Society of Pediatric Cardiology and Cardiac Surgery (2012 revised version).

Guidelines for medical treatment of acute Kawasaki disease: report of the Research Committee of the Japanese Society of Pediatric Cardiology and Cardiac Surgery (2012 revised version).

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%.

Effect of pravastatin on endothelial dysfunction in children with medium to giant coronary aneurysms due to Kawasaki disease.

Ongoing low-grade inflammation and endothelial dysfunction persist in children with coronary lesions diagnosed with Kawasaki disease (KD). Statins, frequently used in the management of high cholesterol, have also shown to improve surrogate markers of inflammation and endothelial dysfunction. This study was undertaken to investigate the efficacy and safety of pravastatin in children with coronary artery aneurysms due to KD. The study enrolled 14 healthy children and 13 male children, aged 2-10 years, with medium-to-giant coronary aneurysms for at least 12 months after the onset of KD. Pravastatin was given orally to the KD group at a dose of 5 mg/day for children under 5 and 10 mg/day for children older than 5 years. To determine the effects of pravastatin on endothelial function, high-frequency ultrasound was performed before the start of the study and 6 months after pravastatin therapy. The parameters measured were brachial artery flow-mediated dilation (FMD), non-flow mediated dilation (NMD), and carotid artery stiffness index (SI). High sensitive C-reactive protein (hs-CRP) levels, the circulating endothelial progenitor cells (EPCs) number, and serum lipid profiles were also determined at baseline and after 6 months of pravastatin treatment. Before treatment, the KD group had significantly decreased FMD (P<0.05) and increased SI and hs-CRP levels (P<0.05) compared with controls. After 6 months of pravastatin therapy, FMD improved significantly compared to the baseline KD group (3.16±6.49 to 10.05±7.74, P<0.05), but remained significantly less than that in the control group with no significant changes in NMD and SI. There were significant decreases in markers of inflammation after treatment. The hs-CRP levels decreased significantly from 2.93±0.81 mmol/L to 2.14±0.82 mmol/L (P<0.05) and the serum apo-B and apo-B/apo-A1 ratio were also reduced (P<0.05) in the KD group. However, the circulating EPC number was not significantly different between baseline and that following pravastatin treatment in the KD group and the control group (P>0.05). No significant complications were noted with paravastatin therapy. Pravastatin improves endothelial function and reduces low-grade chronic inflammation in patients with coronary aneurysms due to KD. Children with coronary aneurysms due to KD may benefit from statin therapy.

Giant Coronary Aneurysms in Kawasaki Disease

La formacion coronaria aneurismatica, con o sin estenosis en el extremo distal de los aneurismas, son caracteristicas bien conocidas de la enfermedad de Kawasaki. Estos aneurismas varian enormemente en gravedad y progresion. Presentamos las imagenes del caso extremo de un nino de 10 anos. El diagnostico de enfermedad de Kawasaki se establecio 2 anos antes del episodio estudiado; entonces se habian identificado aneurismas en la porcion proximal de la arteria coronaria derecha (5 mm) e izquierda (9 mm). Con el tiempo, los aneurismas se agrandaron de manera significativa (20 mm la derecha y 23 mm la izquierda). Ademas, mientras que la arteria coronaria derecha (ACD) se obstruyo, en la arteria descendente anterior (ADA) se desarrollo una estenosis grave, y el paciente sufrio un infarto agudo de miocardio. El estudio angiografico mostro un aneurisma gigante y bloqueo de la ACD y aneurisma gigante y estenosis grave de la ADA. La arteria circunfleja (ACx) tambien mostro una dilatacion aneurismatica significativa, pero sin estenosis (figura 1). Ante esta situacion, se realizo cirugia coronaria (arteria mamaria interna izquierda a la ADA y arteria mamaria interna derecha a la ACD). Las imagenes obtenidas del campo operatorio muestran un aneurisma de la ACD (figura 2A) y de la porcion proximal de la ADA (figura 2B). La evolucion postoperatoria fue favorable y sin eventos adversos. Figura 2. ACD

Giant coronary artery aneurysms in a 58-year-old.

All giant Kawasaki aneurysms may not regress fully; some may eventually calcify, undergo thrombosis, and get detected in asymptomatic adults at later age. Tomisaku Kawasaki initially described this illness as mucocutaneous lymph node syndrome in childhood in 1967 and coronary arteritis was recognized later. We present a 58-year-old male, possibly one of the oldest surviving patients with giant coronary aneurysms who presented with large secundum atrial septal defect (ASD) with heart failure. This indicates that the disease was perhaps prevalent outside Japan even before the first Kawasaki's description.

右冠状動脈右房瘻の1手術例

右冠状動脈右房瘻の1手術例

Two Cases of Super-Giant Coronary Aneurysms after Kawasaki Disease

Acute giant coronary aneurysm after Kawasaki disease (KD) is a catastrophic complication that can be fatal and very difficult to manage. However, no fixed consensus has been reached for the management of super-giant coronary aneurysms in the acute setting. Here, we report the successful management of young children with super-giant coronary aneurysms after KD. Based on our experience, hemodynamic stabilization to prevent further coronary dilation or rupture and strict anticoagulation to avoid thrombus formation are mandatory in the management of this condition.

心室中隔枝に生じた冠動脈瘤の治療経験

心室中隔枝に生じた冠動脈瘤の治療経験

A case of giant coronary aneurysm and acute aortic dissection coexisting with anti-phospholipid antibody syndrome

A case of giant coronary aneurysm and acute aortic dissection coexisting with anti-phospholipid antibody syndrome

Giant mycotic coronary aneurysm associated with late stent infection

A 67-year-old man with a history of paclitaxel-eluting stent implantation in the right coronary artery (RCA) 4 years previously needs below-the-knee amputation of the right leg due to uncontrollable foot infection. The patient had acute high fever and leukocytosis, and performed repeatedly transthoracic echocardiography (TTE) to rule out infective endocarditis. TTE revealed …

Excluding a giant coronary aneurysm by implantation of a covered stent

A 61-year-old gentleman underwent coronary computed tomography (CT) angiography (CCTA) for atypical chest pain, which revealed partially ectatic, diffusely diseased coronary arteries and a giant, eccentric, and partially thrombosed aneurysm in the proximal segment of the right coronary artery (RCA) (size: 7 × 5.5 × 6 cm; Panels A and B , arrows). On invasive angiography, the true size of the aneurysm …

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.

A rare case of giant coronary aneurysms involving both coronary arteries: computed tomographic-angiographic findings

We describe the case of a patient evaluated for the incidental finding of a suspected paracardiac mass. A computed tomography examination demonstrated two giant coronary aneurysms, containing endoluminal thrombi, involving both coronary arteries. Coronary angiography confirmed the diagnosis. The patient underwent surgical treatment because of the high risk of spontaneous rupture of the masses, owing to the early compressive effect especially on the right ventricular free wall.

Multiple giant coronary aneurysms in adult patient managed by exclusion with bypass, case report

Case report A 48 year old male patient presented with angina on effort, chest x-ray revealed increase in the cardiac shadow, CT scan showed multiple aneurismal dilatations in all coronary arteries, with evidence of calcifications, the largest one was 5x5 cm in diameter which was in the proximal segment of left anterior descending artery extended to the proximal left main stem. Coronary angiography showed the same results, but the distal segment of all arteries were free of dilatation, echocardiography showed normal ejection fraction. Our management was by midsternotomy incision, partial cardiopulmonary bypass, with antegrade and retrograde cardioplegia, we bypassed the coronaries by saphenous vein graft to OM,s and PD of RCA and LIMA to distal LAD The ascending aorta was opened left main was closed from inside the aorta, the RCA was legated from its proximal segment, and just distal to the most distal aneurysm, the same done for LAD and Cx . the patient came off bypass smoothly, extubated after 4 hours and he was discharged from the hospital after 6 days with uneventfully early outcome. Conclusion Multiple coronary aneurysms in adults is very rare entity, ischemia is the main presenting complication, many options for treatment depend on the size, distribution, and complications, in our patient the exclusion with bypass was good option with good results but it needs long term follow-up of the patient for long term results.

Comprehensive Evaluation of a Patient with Kawasaki Disease and Giant Coronary Aneurysms with Cardiac Magnetic Resonance

In patients with Kawasaki disease (KD) and coronary artery aneurysms (CAAs), serial evaluation with multiple imaging modalities is recommended to guide risk stratification and management. We present the case of a 7-year-old boy with a history of KD and multiple giant CAAs who developed thrombosis in one of the aneurysms. We illustrate how cardiac magnetic resonance is unique in allowing a comprehensive assessment in patients with severe KD and how it may affect their management.