Multiple Giant Coronary Artery Aneurysms Research Articles

Multiple Giant Coronary Artery Aneurysms with Coronary-Pulmonary Artery Fistula

Multiple Giant Coronary Artery Aneurysms with Coronary-Pulmonary Artery Fistula

Added value of contrast echocardiography for the evaluation of multiple giant coronary artery aneurysms with coronary to pulmonary arterial fistulas.

Added value of contrast echocardiography for the evaluation of multiple giant coronary artery aneurysms with coronary to pulmonary arterial fistulas.

Multiple Giant Coronary Artery Aneurysms in Kawasaki Disease

A 35-year-old man with a history of Kawasaki disease and coronary artery aneurysms (CAAs) at the age of 1 year, for which a coronary artery bypass graft surgical procedure (saphenous vein graft to the left anterior descending [LAD] artery because of the occluded left internal thoracic artery) was performed, presented with dyspnea on exertion. On arrival at our institution, his vital signs were stable, but electrocardiography revealed T-wave inversions in leads V1 through V3. Chest radiography revealed an abnormality of the contour of the left cardiac border (Supplemental Figure 1, available online at http://www.mayoclinicproceedings.org), and chest computed tomography revealed bulky calcified masses on the left ventricle (Supplemental Figure 2, available online at http://www.mayoclinicproceedings.org).

Multiple giant coronary artery aneurysms combined with right coronary artery-pulmonary artery fistula: a case report

BackgroundThe combination of multiple giant coronary artery aneurysms (CAAs) and right coronary artery (RCA) to pulmonary artery (PA) fistula is extremely rare and the patients with CAAs may suffer from several fatal complications. We herein describe a 60-year-old female with hemodynamic instability who was diagnosed with multiple giant CAAs combined with RCA-PA fistula.Case presentationThe patient, a 60-year-old female, presented to the emergency room because of progressive exertional chest distress and fatigue. The transthoracic echocardiography (TTE), coronary computed tomography angiography (CTA) and invasive coronary angiography confirmed the existence of multiple giant CAAs and RCA-PA fistula. Laboratory examinations for systemic vasculitis and infectious diseases demonstrated no abnormalities and work-up for childhood and family history were negative. We have performed a successful surgical treatment for this patient. The patient’s restrictive cardiac dysfunction was improved after debriding the advanced thrombi in aneurysm sac and ligating the fistulous vessel between the native RCA and PA. The postoperative pathologic examination of the aneurysmal wall revealed loss of smooth muscle cells in the media with local mucoid degeneration, no chronic inflammation, sclerosis and IgG4 were observed.ConclusionsThe treatment decision-making process should depend upon the patients’ specific situations. Our case suggests the surgical intervention should be accepted as the preferred treatment for giant CAAs with restrictive cardiac dysfunction.

Abstract 17623: A Case of Biopsy-proven Immunoglobulin G4-Related Disease Associated With Multiple Giant Coronary Artery Aneurysms, Peripheral Arterial Aneurysms, End Stage Renal Disease, and Heart Failure

A 54-year-old man with remote large cell non-Hodgkin’s lymphoma in remission following R-CHOP and severe atopic dermatitis was transferred from another hospital with a non-ST elevation myocardial infarction. Over the preceding year, the patient had suffered recurrent admissions for acutely decompensated heart failure with a newly depressed left ventricular ejection fraction (LVEF) of 20% by echocardiography and rapidly progressive end-stage renal disease of unclear etiology requiring the initiation of hemodialysis. Prior workup had demonstrated an infrarenal abdominal aortic aneurysm and bilateral common iliac artery aneurysms with subsequent computed tomography (CT) additionally demonstrating a superior mesenteric artery aneurysm. The patient was taken for immediate coronary arteriography, which demonstrated giant aneurysms in the left main and right coronary arteries, as well as multivessel severe stenoses. CT coronary angiogram demonstrated significant circumferential wall thickening throughout the coronary vasculature. Given concern for IgG4-related disease (IgG4-RD), a renal biopsy was pursued that confirmed the diagnosis. 18F-fluorodeoxyglucose positron emission tomography-CT identified only mild aortic inflammation. The patient was treated with high-dose steroids and rituximab. The serological inflammatory markers improved, and he underwent coronary artery bypass grafting. Pericardial, aortic adventitial, left internal mammary artery, and saphenous vein biopsies showed cardiovascular involvement of IgG4-RD. The patient has been maintained on rituximab with normalization of his LVEF and no recurrence of chest pain over the past eighteen months. IgG4-RD is a fibroinflammatory systemic disease newly described in 2003 and only recently found to involve the cardiovascular system with several reports of peripheral aneurysmal disease. To our knowledge, the current case represents the first report of a patient successfully treated for biopsy-proven IgG4-RD associated with coronary artery disease and left ventricular systolic dysfunction. IgG4-RD may represent a novel mechanism underlying some forms of peripheral and coronary arterial disease and may offer new insights into vascular biology.

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.

Случай успешного эндоваскулярного лечения множественных гигантских аневризм коронарных артерий

Случай успешного эндоваскулярного лечения множественных гигантских аневризм коронарных артерий

Combined Surgical Approach to Multiple Giant Coronary Artery Aneurysms

Multiple giant coronary artery aneurysms are rare but can develop in the presence of an underlying atherosclerotic vessel disease. Nevertheless, there is no consensus on the ideal surgical treatment or on operative procedures, including aneurysm resection, ligation, distal bypass, and graft interposition. We present the case of a 72-year-old woman with a history of multiple arterial aneurysms who was admitted to the emergency clinic with sudden-onset chest pain and dyspnea. The patient's diagnosis was ischemic heart disease and multiple giant coronary artery aneurysms involving the left anterior descending coronary artery and the proximal and distal segments of the right coronary artery. We present a combined surgical approach to multiple giant coronary artery aneurysms associated with atherosclerosis.

Intraoperative Transesophageal Echocardiography Enables Characterization of Coronary Artery Fistula in Coexistence with Multiple Giant Coronary Artery Aneurysms

Intraoperative Transesophageal Echocardiography Enables Characterization of Coronary Artery Fistula in Coexistence with Multiple Giant Coronary Artery Aneurysms