Giant Coronary Artery Aneurysm Research Articles

Surgical Treatment for Giant Multiple Coronary Artery Aneurysms Caused by an IgG4-Related Disease

Surgical Treatment for Giant Multiple Coronary Artery Aneurysms Caused by an IgG4-Related Disease

Features of diagnosis of incomplete Kawasaki disease in young children. A clinical case of Kawasaki disease with the formation of giant coronary artery aneurysms

Kawasaki disease (KD) is a mucocutaneous lymphonodular syndrome, a vasculitis of unknown etiology that mainly affects children under the age of 5 years. Today, KD is the most common cause of acquired heart disease in children in developed countries. Given the absence of pathognomonic diagnosis of the disease, the diagnosis is based solely on the identification of clinical signs and the exclusion of other clinically similar diseases. Timely therapy with intravenous immunoglobulin has significantly reduced the incidence of complications, such as coronary artery aneurysms, from 25 to ≈ 4 %. The long-term prognosis of the disease depends on the initial and current level of coronary artery damage. Patients with coronary artery aneurysms remain at high risk of developing myocardial ischaemia due to thrombosis and stenosis of the coronary arteries, which can occur in case of untimely treatment for KD. Therefore, the life of these patients depends on lifelong thromboprophylaxis and timely diagnosis of stenosis. The article presents a clinical case of incomplete Kawasaki disease, which was complica­ted by the development of giant coronary artery aneurysms.

Right Coronary Artery Aneurysm Masquerading as a Pericardial Cyst: A Case Report

Coronary artery aneurysms (CAAs) or ectasias are dilatations of arterial segments, commonly detected as an incidental finding during angiography. The incidence of CAAs varies from 0.3% to 5.3%, mainly caused by atherosclerosis, though infections, inflammatory conditions, and connective tissue disorders can also contribute. Giant CAAs are rare with a reported prevalence of 0.02–0.2%. In our case, a 45-year-old female has been diagnosed with a giant aneurysm in the right coronary artery, which was initially misinterpreted as a pericardial cyst. In addition, she has a bicuspid aortic valve and severe aortic stenosis, hence advised for surgical management.

Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature

BackgroundA coronary artery aneurysm (CAA) is an abnormal dilation of a coronary artery segment often accompanied by coronary artery fistula (CAF), leading to communication between a coronary artery and a cardiac chamber or a part of the coronary venous system. Both CAAs and CAFs can present with symptoms and signs of myocardial ischemia and infarction.Case presentationWe describe the case of a 46-year-old woman with non-ST-elevation myocardial infarction (NSTEMI) caused by a “giant” CAA. Various imaging modalities revealed a thrombus-containing aneurysm located at the right-posterior cardiac border, with established arteriovenous communication with the distal part of left circumflex artery (LCx). After initial treatment with dual antiplatelet therapy, a relapse of pain was reported along with a new increase in troponin levels, electrocardiographic abnormalities, reduced left ventricular ejection fraction (LVEF) and thrombus enlargement. Surgical excision of the aneurysm was favored, revealing its true size of 6 cm in diameter. Τhe aneurysm was excised without complications. The patient remained asymptomatic during follow-up.ConclusionsManagement of rare entities such as “giant” CAAs and CAFs can be challenging. Cases such as this can serve as precedents to facilitate treatment plans and develop consistent recommendations, emphasizing the importance of personalized strategies for future patients.

Giant Coronary Artery Aneurysm Associated with Extraluminal Migration of Stent: Role of Multimodal Imaging

Abstract Extraluminal migration of a drug-eluting intracoronary stent into pericardial space with or without aneurysm formation is a rare complication. It is usually symptomatic although rare asymptomatic cases have been described. Herein, we report a 49-year-old male who presented with atypical chest pain 9 years after intracoronary stent implantation in the right coronary artery and the ramus intermediate branch. Echocardiographic examination showed a 7.4 cm × 3.8 cm large oblong cystic mass along the lateral wall of the left ventricle with inward bulging of the adjacent segments. Computed tomography and invasive coronary angiography showed this mass to be a partly thrombosed giant oblong coronary aneurysm arising from the bifurcation of the left main coronary artery with extraluminal migration of the stent from the ramus branch.

Складність діагностики рефрактерної хвороби Кавасакі під «маскою» гемобластозу: клінічний випадок із досвіду гематолога

Kawasaki disease (KD) is an acute systemic vasculitis that is the most common cause of acquired heart disease in children under 5 years of age with hyperthermia. Diagnosis of KD is a clinical challenge, given the wide range of clinical manifestations and similarities with many viral and bacterial diseases. Purpose - to describe a clinical case of refractory КD in a three-month-old girl with an emphasis on the importance of echocardiography and coronary angiography for the final verification of the disease, urgent initiation of treatment with minimal suspicion of КD. Clinical case. The article reports on a three-month-old patient with a difficult diagnosis of refractory form of КD. The disease debuted with hyperthermia, enterocolitis, obstructive bronchitis, and hepatoliver syndrome. The manifestations of skin exanthema were initially considered as an allergic dermatitis to the use of a cephalosporin antibiotic. Multisystemic inflammatory syndrome associated with SARS-CoV-2 infection was suspected. After the use of immunosuppressive therapy with mega-doses of dexamethasone and intravenous human immunoglobulin 2 g/kg/day for 3 days, clinical improvement was achieved. Subsequently, the haemogram showed an increase in neutrophilic hyperleukocytosis to the appearance of blast cells, hyperthrombocytosis and severe anaemia. A differentiation was made between a leukemic reaction, the debut of myeloproliferative disease, juvenile myelomonocytic leukaemia. Against the background of a rapid decrease in the number of leukocytes, the girl developed hyperthermia, migratory intermittent maculopapular rash, and foots edema. Laboratory findings included thrombocytosis and an increase in acute-phase parameters. Echocardiography revealed left ventricular dilation, a small amount of excess fluid in the pericardium, dilatation of the left coronary artery evenly to the bifurcation. Computed tomography revealed giant coronary artery aneurysms, which gave grounds to diagnose KD. The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the parents of child was obtained for the study. No conflict of interests was declared by the authors.

Acute myocardial infarction associated with multiple giant coronary artery aneurysms: a management dilemma.

A 77-year-old man presented with an acute inferior ST-segment elevation myocardial infarction.

[Intermediate and long-term outcomes of transcatheter closure of congenital coronary cameral fistulas in 66 children].

Objective: To evaluate the intermediate and long-term outcomes and technical aspects of transcatheter closure (TCC) of coronary cameral fistulas (CCF) in pediatric patients. Methods: This was a case-control study. All pediatric patients with CCF who underwent TCC between January 2005 and December 2019 were retrospectively reviewed. Data was collected from medical records, including demographic characteristics, procedural details, intraoperative and postoperative serious adverse events, follow-up results and prognosis. Patients with serious adverse events and without serious adverse events were compared regarding their clinical features and CCF characteristics. Comparisons between groups were performed with independent sample t test, chi-square test or Fisher exact test. Results: A total of 66 CCF patients (34 boys, 32 girls, 3.9 (1.9, 6.2) years old, 15 (11, 20) kg) underwent attempted TCC. All of the CCF were all medium or large fistulas including 55 proximal fistulas (83%) and 11 distal fistulas (17%). The CCF originated more frequently from the right coronary artery (38 cases (58%)), followed by the left coronary artery (28 cases (42%)). The incidence of coronary artery aneurysms (CAA) was 61% (40/66).Procedural treatment was achieved in 64 patients and procedural success was achieved in 59 patients (92%). Six (9%) serious adverse events occurred in 5 patients during the perioperative period. Acute complications included procedure-related death in one patient and acute myocardial infarction in one patient. Periprocedural complications occurred in 3 patients at one day postoperatively including acute myocardial infarction (2 cases), occluder detachment (1 case), and tricuspid chordae tendinae rupture (1 case). Clinical follow-up data were available in 58 of the 62 patients who underwent initial successful TCC with a follow-up period of 9.3 (6.5, 13.4) years. Ten adverse events occurred in 9 patients including 5 complications consisted of aortic valve perforation (1 case), coronary thrombosis (1 case), progressive aneurysmal dilation after reintervention (1 case), and new-onset tricuspid valve prolapse with significant regurgitation (2 cases) and large residual shunts due to fistula recanalization (5 cases). Therefore, the incidence of intermediate and long-term adverse events was 17% (10/58). During the periprocedural and follow-up period, 16 adverse events occurred in 13 patients, whereas no adverse events occurred in 51 patients. Patients with seriovs adverse events presented with larger proportion of large CCF (11/13 vs. 39% (20/51), P=0.005), giant CAA (10/13 vs.14% (7/51), P=0.030), and higher mean pulmonary artery pressure ((20±9) vs.(16±6) mmHg, 1 mmHg=0.133 kPa, t=2.02, P=0.048) compared to patients without serious adverse events. Conclusions: TCC in CCF children appears to be effective with favorable intermediate and long-term outcomes. Strict indication of TCC is mandatory.

ST-segment elevation myocardial infarction due to a giant coronary artery aneurysm caused by IgG4-related disease

ST-segment elevation myocardial infarction due to a giant coronary artery aneurysm caused by IgG4-related disease

Giant right coronary artery aneurysm: the saphenous vein bridge technique

A giant coronary artery aneurysm is defined as an irreversible dilation that is 1.5-times more than the diameter of a healthy adjacent coronary artery. It is a rare disease with an incidence of 0.2% to 4.9%. Coronary artery aneurysms are usually corrected with a coronary artery bypass graft. We describe how to perform a saphenous vein bridge to repair a giant coronary artery aneurysm. When applicable, this technique allows sparing of the coronary artery ostia and restores the coronary anatomy.

Multiple Giant Coronary Artery Aneurysms with Coronary-Pulmonary Artery Fistula

Multiple Giant Coronary Artery Aneurysms with Coronary-Pulmonary Artery Fistula

DOACs in Patients With Giant Coronary Artery Aneurysms After Kawasaki Disease

This case series examines outcomes among patients with giant coronary artery aneurysms after Kawasaki disease treated with direct oral anticoagulants (DOACs).

Long-term follow-up of transcatheter closure of congenital coronary cameral fistulas in infants and children: experience from a single center

Abstract Background Transcatheter closure(TCC) has been considered as an effective treatment for anatomically suitable coronary cameral fistulas(CCF).However, limited data are available regarding long-term outcomes TCC of CCF in the pediatric population. Purpose The long-term efficacy and safety of TCC for the management of CCF was investigated in pediatric patients. Methods All pediatric patients(＜18 years old) diagnosed with CCF who were scheduled to undergo TCC between 2005 and 2019 in our center were retrospectively enrolled.CCF anatomic characteristics, procedural techniques, and follow-up outcomes were reviewed. Results 81 patients(42 males, median age 3.24 years) with CCF underwent diagnostic coronary angiography, and 66 patients(median age 3.93 years,median weight 15Kg) underwent attempted TCC of CCF. Immediate successful device implantation was achieved in 62 patients, and immediate complete occlusion was achieved in 44 patients(44/62, 71.0%). The closure procedure was waived in 2 patients because of challenging anatomic structures, and a total of 6 periprocedural complications occurred in 5 patients, including acute myocardial infarction(n=3),procedural-related death(n=1), device embolization(n=1), and rupture of tricuspid chordae tendineae(n=1). The acute procedural success rate was 89.4%(59/66), and the acute complication rate was 9.1%(6/66). Follow-up data were collected for 58 (93.5%) out of 62 patients at a median of 9.3 years(range, 3.0-15.7 years). Among them, 10 adverse events occurred in 9 patients, including 5 follow-up complications(1 aortic valve perforation, 1 coronary thrombosis, 1 progressive aneurysmal dilation after reintervention, 2 new-onset tricuspid prolapse with significant regurgitation), and 5 closure failure with large residual shunts. The long-term adverse event rate was 17.2% (10/58). The angiographic features associated with both acute and long-term adverse were large CCF(P=0.005), and giant coronary artery aneurysm(CAA) (P=0.029). Conclusions TCC of CCF in infants and children appears to be safe and effective. Patients with large CCF and giant CAA may be at higher risk for both acute and long-term adverse events.Patient flow chartClosure strategies of TCC of CCF

Abstract 18043: Massive Right Coronary Artery Aneurysm With a Massive Thrombus Presenting as ST Elevation Myocardial Infarction

Introduction: Coronary artery aneurysm (CAA) is a vessel dilation exceeding 1.5 times adjacent normal segments. We present a case of massive right coronary artery (RCA) aneurysm complicated by ST elevation (STE) myocardial infarction. Case Summary: An 87-year-old female with no significant medical history presented with chest pain. Vitals signs and physical exam were normal. A 12 lead EKG demonstrated STE in inferior leads. Coronary angiography revealed a large aneurysm of the RCA throughout its course (max diameter 20 mm) with TIMI I flow. In the mid RCA, there was a long filling defect with irregular borders consistent with a congealed, organized layered thrombus causing 90% stenosis. Percutaneous coronary intervention (PCI) was not pursued due severe aneurysmal dilation and risk for embolization. The proximal to mid left anterior descending artery (LAD) and abdominal aorta were also aneurysmal. The patient was deemed not to be a surgical candidate after a heart team discussion (STS risk of morbidity or mortality = 12.6%). Left ventricular ejection fraction was 60%. Chest pain resolved and patient was discharged on indefinite anticoagulation and antiplatelet therapy. Discussion: Giant CAAs are rare, with an incidence of 0.02%. Causes include atherosclerosis, Takayasu arteritis, Kawasaki disease, or congenital defects. Although mostly incidental, CAA can be complicated by thrombosis, embolization, fistulation, rupture, arrhythmia, or sudden death. Our patient had an acute RCA thrombus due to stasis and turbulent blood flow in the aneurysm. Localized CAA are treated with surgery or percutaneous coiling or stenting. However, PCI was not feasible in our patient due to risk of embolization and difficultly with stent apposition in the setting of a diffuse, giant-sized aneurysm. Conclusion: CAAs are rare but may cause grave complications. A heart team discussion is essential to guide appropriate medical, percutaneous, or surgical treatment based on vessel anatomy.

Giant right coronary artery aneurysm with right coronary artery-right atrial fistula.

Giant right coronary artery aneurysm with right coronary artery-right atrial fistula.

Rupture of Giant Coronary Artery Aneurysm into Left Atrium Causing Acute Congestive Heart Failure.

Rupture of Giant Coronary Artery Aneurysm into Left Atrium Causing Acute Congestive Heart Failure.

Predictive factors of medium-giant coronary artery aneurysms in Kawasaki disease

BackgroundWe aimed to examine predictive measures for medium and giant coronary artery aneurysms (CAA) in Kawasaki disease (KD) patients.MethodsPatients who were diagnosed with KD from 2015 to 2021 were retrospectively reviewed. The clinical and laboratory data were compared between medium-giant group and non-medium-giant group.ResultsA total of 1331 KD patients were investigated, of whom 63 patients (4.7%) developed medium-giant CAA including 27 patients (2%) with giant CAA. Sex, age, fever duration, intravenous immunoglobulin (IVIG) resistance, platelet count, and albumin level independently predicted medium or giant CAA by multivariate logistic regression analysis. Male, age, duration of fever, IVIG resistance, platelet count, hemoglobin, and erythrocyte sedimentation rate were independent predictors for giant CAA. The two new scoring systems using these factors in identifying patients with medium-giant CAA and giant CAA had respectively sensitivities of 86.89% and 92.59%, and specificities of 81.65% and 87.93%. Validation in 2021 dataset (193 KD patients) showed comparable sensitivity and specificity to development dataset.ConclusionsMale, age, fever duration, IVIG resistance, platelet count, albumin, hemoglobin, and erythrocyte sedimentation rate might be significant predictors of medium and giant CAA. The sensitivity and specificity in our risk prediction model were higher than in previous research.ImpactThis is the first study to search for risk factors and establish a prediction model for the development of medium-giant CAA in the Chinese population using z-scores and absolute inner diameter values based on large sample sizes.The sensitivity and specificity in our model were higher than in previous studies.Our research could help clinicians better predict medium-giant CAA and choose more appropriate treatment.

Incidental Finding of a Giant Left Main Coronary Artery Aneurysm as an Anterior Mediastinal Mass.

Incidental Finding of a Giant Left Main Coronary Artery Aneurysm as an Anterior Mediastinal Mass.

면역 글로불린 저항성을 보인 5명의 가와사키병 환아에서의 혈장 교환술을 통한 치료

The efficacy of high-dose intravenous immunoglobulin (IVIG) treatment for acute-stage Kawasaki disease patients has become widely recognized. However, in the case of refractory Kawasaki disease, alternative treatment should be considered to prevent coronary artery abnormality (CAA). Here, we present several cases of Kawasaki disease in children treated with plasma exchange (PE). We retrospectively reviewed the medical records of 5 subjects who had been unresponsive to IVIG treatments and treated with PE consecutively. The fever subsided and the other clinical manifestations were improved after PE in all cases. In two cases, giant coronary artery aneurysms were detected on echocardiographic follow-up study. PE should be a method with promising efficacy and might be considered in refractory Kawasaki disease patients for whom other treatment options have failed.

Coronary Artery Involvement in Kawasaki Disease-Echocardiographic Evaluation of Cases in a Tertiary Care Hospital

Background: Kawasaki disease (KD) is the leading cause of childhood acquired heart disease. Cardiovascular manifestations can be prominent in the acute phase of the illness. Echocardiography is useful in recognizing these cardiac manifestations. We carried out a retrospective study by analyzing the data of Kawasaki disease patients in a tertiary care hospital. Methods: The prevalence of coronary artery dilatation and clinical outcome were documented. Clinical, laboratory, and echocardiographic findings were obtained at baseline and 1 week, 6 weeks after initial therapy with intravenous immunoglobulin in addition to high doses of Aspirin which reduces the risk of coronary artery aneurysm. Results: One hundred and forty-nine patients with mean age 3± 2 years old, 60% males with Kawasaki disease were included. One hundred and thirty-two patients had coronary involvement (left main coronary artery 36.37 %, left anterior descending artery 28.03%, right main coronary artery 24.25%, circumflex branch in 11.37%). Administration of intravenous immunoglobulin (IVIG) and aspirin has greatly reduced the incidence of coronary lesions in affected children. The initial cardiac findings developed over first few weeks of illness resolved in most of the cases in the subsequent echocardiogram studies after IVIG. The mean duration to normalization of abnormal echocardiography findings is 6±3 months. Conclusion: Coronary artery involvement is seen in most of children with Kawasaki disease. Intravenous gamma globulin and aspirin has been reported to reduce the likelihood of development of giant coronary artery aneurysms and appears to have a direct beneficial effect on abnormalities in cardiac function associated with the acute phase of Kawasaki disease. Cardiovasc j 2023; 15(2): 144-150