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1
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Kamio T, Kamio M, Kamio T. A rare case of successful staged surgery for giant coronary artery aneurysm, multiple artery aneurysms, and coronary-to-pulmonary artery fistula. J Surg Case Rep 2025; 2025:rjaf154. [PMID: 40104000 PMCID: PMC11915844 DOI: 10.1093/jscr/rjaf154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Accepted: 03/04/2025] [Indexed: 03/20/2025] Open
Abstract
Large coronary artery aneurysms (CAAs) with multiple arterial involvements are rare, and complications like coronary artery fistulae are extremely uncommon. Managing such cases presents a significant challenge. A 75-year-old female presented with a left inguinal mass and palpitations. Computed tomography revealed an abdominal aortic aneurysm and a left common iliac artery aneurysm. Coronary angiography identified a giant CAA and a coronary-to-pulmonary artery fistula. She underwent a two-stage surgical approach: first, an aortobiiliac Y-graft interposition, followed by open-heart surgery for aneurysmectomy and ligation of the pulmonary artery fistula 4 months later. Her postoperative course was uneventful, and she remained well at the 1-year follow-up. This case shows that prioritizing the aneurysm with the highest rupture risk, followed by staged treatment of CAAs, can lead to successful outcomes without major complications.
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Affiliation(s)
- Tadashi Kamio
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama 330-8503, Japan
| | - Manabu Kamio
- Department of General Medicine, Yokosuka Uwamachi Hospital, 2-36 Uwamachi, Yokosuka, Kanagawa 238-8567, Japan
| | - Takashi Kamio
- Department of Oral and Maxillofacial Radiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo 102-8159, Japan
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2
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Mousa M, Mahmoud IZ, Elkammash TH, Gad AA, Noureldin RA. Cardiac Magnetic Resonance in Association With Coronary CT Angiography in the Assessment of Right Coronary Artery Aneurysm With Atrial Fistula Causing Myocardial Ischemia. Cureus 2025; 17:e77218. [PMID: 39925522 PMCID: PMC11807290 DOI: 10.7759/cureus.77218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2025] [Indexed: 02/11/2025] Open
Abstract
Coronary artery aneurysms are uncommon. Atherosclerosis is the primary etiology, and the right coronary artery (RCA) is the most frequently involved. We present a case of a 65-year-old male patient presenting with ischemic symptoms and a giant right coronary artery aneurysm with a fistula to the right atrium. The diagnosis was established using non-invasive imaging modalities, including cardiac magnetic resonance (CMR) and coronary computed tomography angiography (CCTA). This case underscores the critical role of a combined imaging approach in effectively managing such rare and complex coronary artery conditions. The collaboration of CMR, providing data on myocardial viability and thrombus, with CCTA, offering precise anatomical details, enables clinicians to gain a comprehensive understanding of the aneurysm and its complications. This integrated approach guides optimal treatment strategies and ultimately improves patient outcomes.
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Affiliation(s)
- Mohammed Mousa
- Department of Diagnostic and Interventional Radiology, Suez Canal University, Ismailia, EGY
| | - Islam Z Mahmoud
- Department of Cardiovascular Medicine, Suez Canal University, Ismailia, EGY
| | - Tarek H Elkammash
- Department of Diagnostic and Interventional Radiology, Suez Canal University, Ismailia, EGY
| | - Azza A Gad
- Department of Diagnostic and Interventional Radiology, Suez Canal University, Ismailia, EGY
| | - Radwa A Noureldin
- Department of Diagnostic and Interventional Radiology, Suez Canal University, Ismailia, EGY
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3
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Rokyta O. MINOCA as the result of coronary artery aneurysm thrombosis. J Int Med Res 2024; 52:3000605241301859. [PMID: 39660402 PMCID: PMC11632892 DOI: 10.1177/03000605241301859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 11/04/2024] [Indexed: 12/12/2024] Open
Abstract
Myocardial infarction (MI) can be caused by many factors. In addition to the typical obstruction or stenosis of the coronary arteries, there is heterogenic MI with non-obstructive coronary arteries (MINOCA). A rare cause of MINOCA is the thrombosis of a coronary artery aneurysm (CAA). This current case report describes a male patient with CAA thrombosis as the cause of MINOCA following surgery for a mucoepidermoid carcinoma. The patient underwent angiography that identified three CAAs that were located as follows: (i) in the proximal part of the left anterior descending artery (5.55 mm); (ii) in the distal part of the circumflex artery (8.05 mm); and (iii) in the distal part of the right coronary artery (6.61 mm). Thrombotic masses were identified within all three structures. The patient received balloon angioplasties without stent implanting and recovered well. The patient was also notable for the presence of two brain artery aneurysms that were the cause of the previous strokes that he had experienced. This case report also reviews the literature in order to: (i) summarize the aetiological factors and clinical manifestations of CAA; (ii) discuss the diagnostic methods for CAA; (iii) describe the medical and surgical management of CAA; and (iv) assess the prognosis of this rare clinical event.
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Affiliation(s)
- Oksana Rokyta
- Department of Internal Medicine No. 2, Bogomolets National Medical University, Kyiv, Ukraine
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4
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Aslam U, Kumar U, Gupta A, Iyengar N, Khalpey Z. Surgical Management of a Ruptured Giant Right Coronary Artery Aneurysm With Fistulization. Cureus 2024; 16:e69177. [PMID: 39398764 PMCID: PMC11468359 DOI: 10.7759/cureus.69177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2024] [Indexed: 10/15/2024] Open
Abstract
Coronary artery aneurysms (CAAs) are an uncommon condition with severe long-term consequences. We describe the surgical treatment of a right CAA that manifested as a compressive mass adjacent to the right atrium. A 60-year-old female patient presented with mid-sternal chest discomfort and a CT scan showing a 6.3cm x 5.5cm x 7cm mass along the anterior chest wall compressing the right atrium. Angiography revealed 95% proximal right coronary artery stenosis with contrast filling a giant CAA but no antegrade filling beyond the aneurysmal sac. While hospitalized, the patient experienced acute hypotension, and an urgent CT scan demonstrated interval bleeding into the pericardial sac with significant external compression of the right ventricular outflow. The patient was urgently taken to the operating room, where the right CAA was ligated at the neck and oversewn at the ostium. The patient developed a hemothorax on postoperative day 1 without a clear source of bleeding, but the remaining postoperative course was uneventful. Opportunities for surgery in patients with ruptured CAAs are rare due to the high pre-hospital mortality rate. Complex percutaneous coronary intervention is the preferred initial approach for asymptomatic CAAs, as was performed in this patient eight years prior. However, in the setting of acute tamponade, urgent operative intervention is the only viable management option. Aneurysmal rupture is an uncommon complication of CAAs that frequently leads to sudden death. This case demonstrates the successful management of an acutely ruptured CAA with urgent aneurysm ligation.
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Affiliation(s)
- Usman Aslam
- Department of General Surgery, HonorHealth, Phoenix, USA
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
| | - Ujjawal Kumar
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
- School of Clinical Medicine, University of Cambridge, Cambridge, GBR
| | - Ankur Gupta
- Department of Cardiology, HonorHealth, Scottsdale, USA
| | | | - Zain Khalpey
- Department of Cardiothoracic Surgery, HonorHealth, Scottsdale, USA
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5
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Ganni E, Béïque F, Hatzigeorgiou S, Morin JF, Kovacina B, Peretz-Larochelle M. An Unusual Cause of Shock: Bursting a Bubble. JACC Case Rep 2024; 29:102394. [PMID: 39157571 PMCID: PMC11328778 DOI: 10.1016/j.jaccas.2024.102394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 08/20/2024]
Abstract
This study presents the case of a previously healthy 68-year-old woman who presented with shock from tamponade due to hemopericardium. Initial noninvasive imaging did not provide a clear etiology for the hemopericardium. Given the ongoing clinical deterioration and need for diagnosis and treatment, an exploratory sternotomy was performed with successful outcome.
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Affiliation(s)
- Elie Ganni
- Department of Internal Medicine, McGill University, Montreal, Quebec, Canada
| | - François Béïque
- Department of Anesthesiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Sean Hatzigeorgiou
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jean-François Morin
- Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Bojan Kovacina
- Department of Radiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Maude Peretz-Larochelle
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- Division of Critical Care Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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6
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Almadwahi NY, Alshuja’a MA, Al-Hodiafy HZ, Jowah HM. A Rare Case of Gastroduodenal Artery Aneurysm Rupture with Perforated Duodenal Ulcer. Int Med Case Rep J 2024; 17:609-614. [PMID: 38911607 PMCID: PMC11192190 DOI: 10.2147/imcrj.s468278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/14/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose In this case we report a rare presentation of a ruptured gastroduodenal artery aneurysm (GDA) accompanied by a duodenal perforation. It contributes to the scientific literature by discussing the management approach and results in a patient with dual complications and emphasizes the importance of early diagnosis and appropriate treatment. Case presentation A 50-year-old male presented with severe abdominal pain, anemia, and signs of hemodynamic instability. Diagnostic imaging including CTA revealed a large, thrombosed gastroduodenal artery aneurysm with evidence of rupture. The patient underwent open surgical exploration and repair to address both the aneurysm and the duodenal perforation. The patient's recovery was satisfactory and was discharged home in stable condition. Conclusion Early diagnosis and appropriate management in gastroduodenal artery aneurysms is crucial. There is a need for individualized surgical interventions based on the patient's hemodynamic status and associated complications. Dual complications required open surgical exploration and repair, resulting in favorable outcomes.
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Affiliation(s)
| | | | - Hamza Zaid Al-Hodiafy
- Department of Vascular Surgery, 48 Model Hospital, Sana’a University, Sana’a City, Yemen
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7
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Ahmed JA, Ahmed KA, Ahmed MH. Ranolazine as a First-Choice Anti-anginal Medication for Patients With Coronary Artery Ectasia: A Case Series. Cureus 2024; 16:e52747. [PMID: 38384654 PMCID: PMC10881230 DOI: 10.7759/cureus.52747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/23/2024] Open
Abstract
Coronary artery ectasia (CAE) is characterized by the abnormal dilation of coronary arteries, resulting in disturbed or slow blood flow, which causes angina pectoris-the most prevalent symptom of CAE. To date, there is no consensus on the therapeutic management of CAE due to its rarity and the scarcity of research. We present a case series of five patients with different ethnicities, including both men and women, whose CAE was successfully managed by the administration of ranolazine. All five patients were found to have CAE by coronary angiography, which was also associated with slow blood flow. Clinically, the patients had accelerating angina. They were prescribed an initial dose of 500 mg of ranolazine twice daily, which led to the resolution of their anginal symptoms. They have been clinically and hemodynamically stable for the last several years. In light of these results, we propose that ranolazine be considered as a first-choice anti-anginal medication for patients with CAE.
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8
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Scarpa J, Zhu A, Morikawa NK, Chan JM. Perioperative Management of Giant Coronary Artery Aneurysm. J Cardiothorac Vasc Anesth 2023; 37:2040-2045. [PMID: 37296024 DOI: 10.1053/j.jvca.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/04/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Julia Scarpa
- Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY
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9
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Lionakis N, Briasoulis A, Zouganeli V, Koutoulakis E, Kalpakos D, Xanthopoulos A, Skoularigis J, Kourek C. Coronary Artery Aneurysms: Comprehensive Review and a Case Report of a Left Main Coronary Artery Aneurysm. Curr Probl Cardiol 2023; 48:101700. [PMID: 36931332 DOI: 10.1016/j.cpcardiol.2023.101700] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
Coronary artery aneurysms (CAAs) are rare anatomical disorders of the coronary arteries. Atherosclerosis and Kawasaki disease are the principal causes of CCAs, while other causes including genetic factors, inflammatory arterial diseases, connective tissue disorders, endothelial damage after cocaine use, iatrogenic complications after interventions and infections, are also common among patients with CAAs. Although there is a variety of noninvasive methods including echocardiography, computed tomography, and magnetic resonance imaging, coronary angiography remains the gold standard diagnostic method. There is still no consensus about the most appropriate therapeutic strategy. Medical therapy including antiplatelets, anticoagulants, statins and ACEs are preferred either in patients with atherosclerosis, inflammatory status and stable CAAs, while percutaneous or surgery interventions are usually applied in patients with acute coronary syndrome due to a CAA culprit, obstructive coronary artery disease or large saccular aneurysms at a high risk of rupturing.
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Affiliation(s)
- Nikolaos Lionakis
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, Alexandra Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece; Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa Hospitals and Clinics, IA 52242, United States
| | - Virginia Zouganeli
- Second Cardiology Department, Attikon University Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Emmanouil Koutoulakis
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Dionisios Kalpakos
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Christos Kourek
- Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens 11521, Greece.
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10
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Christodoulou KC, Stakos D, Androutsopoulou V, Chourmouzi-Papadopoulou M, Tsoucalas G, Karangelis D, Fiska A. Vieussens' Arterial Ring: Historical Background, Medical Review and Novel Anatomical Classification. Cureus 2023; 15:e40960. [PMID: 37378305 PMCID: PMC10291275 DOI: 10.7759/cureus.40960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 06/29/2023] Open
Abstract
In coronary artery disease, the presence of Vieussens' arterial ring (VAR), a ring-shaped anastomosis between the conus branch of the right coronary artery with the left anterior descending artery (LAD), will allow blood flow to return to the obstructed coronary system. We have conducted a literature review, aiming to collect all the existing information about the documented VAR cases and any related pathological conditions. A total of 54 studies entered the review, including 56 patients. The mean age of the patients was 56.12 ± 16.2 years. Angina was present in 53.6% of the patients, with 7.2% of the cases being asymptomatic. Coronary artery disease outweighed (58.9%) as the patients' most frequent diagnosis. We propose a novel VAR anatomical classification, based on the sites of origin and termination of its course, with six distinct types, for a better understanding and surgical management of VAR. Type IA, originating from the conus branch and terminating in the proximal segment of the LAD was most frequently reported (51.8%). The recognition and the subsequent evaluation of the ring's anatomy and course are crucial for a customized clinical intervention. When right and left coronary angiographies fail to reveal any collateral circulation, selective conus artery catheterization should be in order. The proposed classification offers a manageable and comprehensive context for the assessment, evaluation and planning of therapeutic strategies of VAR and sets a new terminology frame for treatment guidelines.
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Affiliation(s)
- Konstantinos C Christodoulou
- Laboratory of Anatomy, School of Medicine, Democritus University of Thrace, Alexandroupolis, GRC
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, GRC
| | - Dimitrios Stakos
- Department of Cardiology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, GRC
| | - Vassiliki Androutsopoulou
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, GRC
| | | | - Gregory Tsoucalas
- Department of History of Medicine and Medical Deontology, School of Medicine, University of Crete, Heraklion, GRC
| | - Dimos Karangelis
- Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, GRC
| | - Aliki Fiska
- Laboratory of Anatomy, School of Medicine, Democritus University of Thrace, Alexandroupolis, GRC
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11
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Pekkoc-Uyanik KC, Aslan EI, Kilicarslan O, Ser OS, Ozyildirim S, Yanar F, Yildiz A, Ozturk O, Yilmaz-Aydogan H. Next-generation sequencing of prolidase gene identifies novel and common variants associated with low prolidase in coronary artery ectasia. Mol Biol Rep 2023; 50:1349-1365. [PMID: 36462085 DOI: 10.1007/s11033-022-08142-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Decreased collagen biosynthesis and increased collagenolysis can cause ectasia progression in the arterial walls. Prolidase is a key enzyme in collagen synthesis; a decrease in prolidase activity or level may decrease collagen biosynthesis, which may contribute to ectasia formation. Considering that, the variations in PEPD gene encoding prolidase enzyme were evaluated by analyzing next-generation sequencing (NGS) for the first time together with known risk factors in coronary artery ectasia (CAE) patients. METHODS Molecular analysis of the PEPD gene was performed on genomic DNA by NGS in 76 CAE patients and 76 controls. The serum levels of prolidase were measured by the sandwich-ELISA technique. RESULTS Serum prolidase levels were significantly lower in CAE group compared to control group, and it was significantly lower in males than females in both groups (p < 0.001). On the other hand, elevated prolidase levels were observed in CAE patients in the presence of diabetes (p < 0.001), hypertension (p < 0.05) and hyperlipidemia (p < 0.05). Logistic regression analysis demonstrated that the low prolidase level (p < 0.001), hypertension (p < 0.02) and hyperlipidemia (p < 0.012) were significantly associated with increased CAE risk. We identified four missense mutations in the PEPD gene, namely G296S, T266A, P365L and S134C (novel) that could be associated with CAE. The pathogenicity of these mutations was predicted to be "damaging" for G296S, S134C and P365L, but "benign" for T266A. We also identified a novel 5'UTR variation (Chr19:34012748 G>A) in one patient who had a low prolidase level. In addition, rs17570 and rs1061338 common variations of the PEPD gene were associated with low prolidase levels in CAE patients, while rs17569 variation was associated with high prolidase levels in both CAE and controls (p < 0.05). CONCLUSIONS Our findings indicate that the low serum prolidase levels observed in CAE patients is significantly associated with PEPD gene variations. It was concluded that low serum prolidase level and associated PEPD mutations may be potential biomarkers for the diagnosis of CAE.
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Affiliation(s)
- Kubra Cigdem Pekkoc-Uyanik
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Department of Medical Biology, Faculty of Medicine, Halic University, Istanbul, Turkey
| | - Ezgi Irmak Aslan
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Onur Kilicarslan
- Department of Cardiology, Institute of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozgur Selim Ser
- Department of Cardiology, Institute of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serhan Ozyildirim
- Department of Cardiology, Institute of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatih Yanar
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Department of Molecular Biology and Genetics, Bogazici University, Istanbul, Turkey
| | - Ahmet Yildiz
- Department of Cardiology, Institute of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Oguz Ozturk
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Hulya Yilmaz-Aydogan
- Department of Molecular Medicine, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
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12
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"Floating" Stent in a Coronary Aneurysm Presenting as ST-Elevation Myocardial Infarction. J Cardiovasc Dev Dis 2023; 10:jcdd10020059. [PMID: 36826555 PMCID: PMC9962825 DOI: 10.3390/jcdd10020059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Coronary artery aneurysm (CAA) presenting as an ST-elevation myocardial infarction (STEMI) represents a clinical challenge due to the technical difficulties in the percutaneous management of this specific situation. Appropriate treatment for CAA depends on the precise clinical situation and consists of medical management, surgical resection, or/and stent placement. The high rate of complications during percutaneous intervention (distal thrombus embolization, no-reflow phenomenon, stent malposition, or dissection) makes emergent surgery a frequent situation in these cases. We present the case of a 50-year-old man with a STEMI due to thrombotic occlusion of CAA. Specific angiographic techniques and intracoronary imaging help with the percutaneous management of acute thrombotic occlusions in CAA, providing a less invasive approach than emergent surgery.
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13
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Zhang Q, Zhang T, Zhu J, Ling F, Wang Q, Deng K, Lei H, Zhou Z, Yang D, Ge J. A Case of Giant Left Circumflex Coronary Fistula Aneurysm with Unidentified Fistula. Int Heart J 2023; 64:775-778. [PMID: 37518357 DOI: 10.1536/ihj.22-082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
A coronary aneurysm is a rare type of cardiovascular disease. We report a case of a 53-year-old male patient who presented to our hospital with a giant left circumflex coronary fistula aneurysm (LCCA) (75 mm × 70 mm). Since coronary angiography and coronary computed tomography angiography failed to detect the fistula of the coronary aneurysm, interventional occlusion surgery could not be performed. We discovered the fistula in the right atrium by anterograde perfusion with blood-containing myocardial protective fluid after switching to intraoperative exploration during cardiac surgery. The coronary aneurysm's fistula and inlet were then sutured, and the aneurysm was resected. The patient recovered successfully after the operation. This case was instructive in managing LCCA, especially with an unidentified fistula.
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Affiliation(s)
- Qiong Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
| | - Tao Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
| | - Jirong Zhu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
| | - Fei Ling
- Department of Cardiovascular Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
| | - Qi Wang
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
| | - Kexue Deng
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
| | - Hong Lei
- Department of Cardiovascular Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
| | - Zhengchun Zhou
- Department of Cardiovascular Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
| | - Dongmei Yang
- Department of Echocardiography, The First Affiliated Hospital of University of Science and Technology of China
| | - Jianjun Ge
- Department of Cardiovascular Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
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14
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Gersch S, Baraki H, Toischer K. Progression and interventional therapy of a coronary pseudoaneurysm: a case report. Eur Heart J Case Rep 2022; 7:ytac478. [PMID: 36582593 PMCID: PMC9793774 DOI: 10.1093/ehjcr/ytac478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Background Coronary pseudoaneurysms (PSAs) occur as a rare complication following drug-eluting stent implantation and have been reported to occur between 1 week and 4 years after implantation. Most of them remain in a stable state, but progression of PSAs increases the risk of rupture and haemorrhagic cardiac tamponade. Case summary Here, we present a case of a 55-year-old patient, who developed a PSA of the proximal left circumflex artery after stent implantation of the left main artery, left anterior descending artery, and left circumflex artery. Within <1 year, the patient was readmitted to different hospitals due to cardiac decompensation and myocardial infarction. Thereafter, coronary angiography and computed tomography scans were performed, and progression of the PSA could be documented. Interventional therapy was chosen due to the high surgical risk of the patient. Implantation of a covered stent from the left main artery into the left anterior descending artery was chosen to treat the PSA, thereby silencing the chronically occluded left circumflex artery, followed by dilatation with a non-compliant balloon. The patient has remained asymptomatic in a 6-month follow-up. Discussion Coronary PSA should be controlled with respect to progression, and appropriate therapy can be chosen for treatment.
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Affiliation(s)
- Svante Gersch
- Department of Cardiology and Pneumology, University Medical School Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Hassina Baraki
- Department of Cardiovascular and Thoracic Surgery, University Medical School Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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15
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van Grinsven V, Binst A, Rombouts H, Symons R, De Praetere H. Giant right coronary artery aneurysm with vena cava superior fistula: a case report and radiological findings. THE CARDIOTHORACIC SURGEON 2022. [DOI: 10.1186/s43057-022-00081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Giant coronary artery aneurysms (GCAA) are a rare disease entity with an estimated incidence of 0.02%. Atherosclerosis is the most common underlying factor in adulthood. Management guidelines lack the support of large-scale studies.
Case presentation
We present a case of a 58-year-old Caucasian male with complaints of stable dyspnea who was found to have a GCAA of the right coronary artery (RCA). Further evaluation revealed an aneurysm of 5.0 cm in diameter with a tortuous course, fistulation to the distal vena cava superior, and mass effect on the left atrium. Surgical deroofing and ligation of the aneurysm with venous bypassing of the right coronary artery were performed. There were no postoperative complications. Cardiac function had improved at 1-month follow-up and remained improved at 1-year follow-up.
Conclusions
Diagnosis and treatment strategy concerning GCAA remain challenging. Surgical treatment is advised in cases of giant aneurysms, multivessel disease, left main coronary artery (LMCA) involvement, mechanical complications (fistula, compression, or rupture), and concomitant valve surgery. Coronary angiography remains the gold standard for evaluation. However, coronary computed tomography angiography (CCTA) and cardiac magnetic resonance imaging (CMR) can add an important value for the clinician to assess myocardial viability and planning of surgical intervention.
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16
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du Fretay XH, Aubry P. [Imaging of coronary aneurysms in adults' coronary aneurysms]. Ann Cardiol Angeiol (Paris) 2022; 71:391-398. [PMID: 36241480 DOI: 10.1016/j.ancard.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Coronary aneurysms are rare and of various etiologies in adults. Natural history, modalities of management and clinical monitoring remain poorly known due to the lack of large studies and homogeneous diagnostic and follow-up criteria in the published data. Coronary angiography is, so far, the most common diagnostic tool but can overlook some partially thrombosed aneurysmal. Intracoronary imaging, particularly intravascular ultrasound, can differentiate aneurysms from pseudoaneurysms considered by some to be at greater risk of events, requiring a curative treatment. Intracoronary imaging can also help with etiological assessment and percutaneous treatment. With its growing use in the search for coronary atheromatous disease, coronary CT angiography has become a major diagnostic tool for coronary aneurysms. In addition, that it can incidentally detect coronary aneurysms, coronary CT angiography is particularly useful for giant aneurysms poorly visualized on coronary angiography or less well evaluated by intracoronary imaging. It specifies their relationship with adjacent anatomical structures. It is also a non-invasive modality of monitoring. These three imaging tools are currently the most relevant in current practice pending large studies evaluating the natural history of coronary aneurysms, with the identification of possible risk factors that could modify the management.
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Affiliation(s)
- Xavier Halna du Fretay
- Département de Cardiologie, Hôpital Bichat Claude-Bernard, 75018, Paris, France; Cardioreliance, 45770, Saran, France.
| | - Pierre Aubry
- Département de Cardiologie, Hôpital Bichat Claude-Bernard, 75018, Paris, France; Service de Cardiologie, Centre Hospitalier de Gonesse, 95500, Gonesse, France
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17
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Gallego DF, Ruiz MEZ, Marshall DA. Oblivion: autopsy findings of a 31-year-old man with sudden cardiac arrest, a case report of a sequalae of Kawasaki disease. Autops Case Rep 2022; 12:e2021404. [PMID: 36312877 PMCID: PMC9613377 DOI: 10.4322/acr.2021.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
A 31-year-old man presented to the hospital after suffering a sudden cardiac arrest. Despite optimal therapy, the patient passed away. His medical history included febrile rash at age 2. At autopsy, there was aneurysmal dilation and severe coronary artery stenosis by atherosclerotic plaques and myocardial fibrosis. These findings were presumed to be due to complications of Kawasaki disease, given the remote history of severe febrile rash as a toddler and the presence of chronic coronary artery injury, recanalization, and thrombosis with ischemic heart disease leading to sudden cardiac collapse and death.
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Affiliation(s)
| | - Maria Eugenia Zuluaga Ruiz
- Universidad del Valle, Grupo de Investigación en Rehabilitación de la Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - Desiree Ann Marshall
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, Washington, United States
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18
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Negro F, Gentile F, Rizza A, Giannoni A, Bianchi G, Clemente A, Emdin M, Palmieri C. Etiology, clinical presentation, and management of left main coronary artery aneurysms. J Card Surg 2022; 37:3675-3686. [PMID: 35989523 DOI: 10.1111/jocs.16870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/11/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY The widespread use of noninvasive/invasive coronary imaging increased the probability of recognition of coronary aneurysms. Left main coronary aneurysms (LMCA), though rare, are potentially life-threatening but in the absence of controlled studies, guidelines do not provide any specific recommendation for their management. We, therefore, aimed to investigate the epidemiology, clinical presentation, therapeutic strategies, and prognostic implication of LMCA. METHODS A systematic review of the literature was performed to retrieve all the reported cases of LMCA as of December 2021, which were summarized and classified according to their etiology, clinical presentation, and therapeutic management. RESULTS Out of 1997 works retrieved, 180 studies were analyzed, describing 209 LMCA cases (aged 51 ± 19 years, 68% males). Atherosclerosis was the most common etiology (40%), followed by inflammatory (12%), congenital (9%), or degenerative (6%) conditions. Stable angina (43%) and acute coronary syndromes (32%) were more often the first clinical manifestations, while 29 (14%) LMCA were incidental findings. Most cases were treated surgically (53%), while percutaneous intervention was rarely adopted (7%). Data about antithrombotic therapies were scarce and heterogeneous. Finally, when longitudinal data were reported (n = 81), LMCA resulted associated with a severe prognosis, with a 15% mortality over an 8-month median follow-up. CONCLUSIONS LMCA are most frequently, but not exclusively, caused by advanced atherosclerosis. Irrespective of their etiology and clinical presentation, LMCA may be associated with high short-term mortality. In absence of controlled studies, a careful evaluation of each case is warranted to optimize therapeutic strategies.
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Affiliation(s)
- Francesco Negro
- Division of Cardiology, Pisa University Hospital, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy
| | - Francesco Gentile
- Division of Cardiology, Pisa University Hospital, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy
| | - Antonio Rizza
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy
| | - Alberto Giannoni
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy.,Health Science Interdisciplinary Research Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giacomo Bianchi
- Division of Adult Cardiac Surgery, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Alberto Clemente
- Division of Radiology, Fondazione Toscana "G. Monasterio", Pisa, Italy
| | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy.,Health Science Interdisciplinary Research Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Cataldo Palmieri
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana "G. Monasterio", Pisa, Italy
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19
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Araiza-Garaygordobil D, Gopar-Nieto R, Sierra-Lara Martínez D, Belderrain-Morales N, Sarabia-Chao V, Alfaro-Ponce DL, Ontiveros-Mercado H, Mendoza-García S, Altamirano-Castillo A, Martinez-Amezcua P, Cabello-López A, Briseño-De la Cruz JL, Ruiz-Beltrán M, Martínez-Ríos MA, Piña-Reyna Y, Gonzalez-Pacheco H, Arias-Mendoza A. Dual Antiplatelet Therapy Versus Antiplatelet Monotherapy Plus Oral Anticoagulation in Patients with Acute Coronary Syndrome and Coronary Artery Ectasia: Design and Rationale of OVER-TIME Randomized Clinical Trial. High Blood Press Cardiovasc Prev 2022; 29:463-468. [PMID: 35904750 DOI: 10.1007/s40292-022-00535-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022] Open
Abstract
INTRODUCTION The optimal anti-thrombotic therapy to prevent recurrent ischemic events in patients with acute coronary syndrome and coronary artery ectasia (CAE) remains unclear. AIM To assess the efficacy and safety of antiplatelet plus anticoagulant therapy versus dual antiplatelet therapy in patients with acute coronary syndromes and coronary artery ectasia. METHODS OVER-TIME is an investigator initiated, exploratory, open label, single center, randomized clinical trial comparing dual antiplatelet therapy (acetyl-salicylic acid plus a P2Y12 inhibitor) with the combination of an antiplatelet monotherapy (a P2Y12 inhibitor) plus a low dose anticoagulant (rivaroxaban, 15mg oral dose) for the prevention of recurrent ischemic events among patients with CAE. We aim to enroll approximately 60 patients with CAE and acute coronary syndromes. After recruitment, patients are randomized to (a) standard of care (dual antiplatelet regimen) or (b) the combination of antiplatelet monotherapy and low dose anticoagulant. Patients will be followed for at least 12 months. The OVER-TIME study aims to assess the efficacy of the regimen in prevention of major cardiovascular events and its security in bleeding events in acute coronary syndromes among patients with CAE. Expected results and conclusions: OVER-TIME is the first randomized controlled trial to assess different antithrombotic strategies in patients with CAE and acute coronary syndrome, and its results will offer preliminary data for the prevention of major cardiovascular events and bleeding events in this group of patients. TRIAL REGISTRATION NUMBER NCT05233124 (ClinicalTrials.gov), date of registration: February 10, 2022.
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Affiliation(s)
- Diego Araiza-Garaygordobil
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico.
| | - Rodrigo Gopar-Nieto
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
| | - Daniel Sierra-Lara Martínez
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
| | - Nallely Belderrain-Morales
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
| | - Vianney Sarabia-Chao
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
| | - Diana Laura Alfaro-Ponce
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
| | - Heriberto Ontiveros-Mercado
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
| | - Salvador Mendoza-García
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
| | - Alfredo Altamirano-Castillo
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
| | - Pablo Martinez-Amezcua
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, USA
| | - Alejandro Cabello-López
- Occupational Health Research Unit, Centro Médico Nacional Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Jose Luis Briseño-De la Cruz
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
| | - Maximiliano Ruiz-Beltrán
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
| | | | - Yigal Piña-Reyna
- Interventional Cardiology, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - Hector Gonzalez-Pacheco
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
| | - Alexandra Arias-Mendoza
- Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Juan Badiano 1, Belisario Dominguez Sección XVI, Tlalpan, 14030, Mexico City, Mexico
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20
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Bashyal K, Koirala B, Bhattarai A, Baral RK, Khakural P, Shakya S, Kadel PB. Spectrum of coronary anomalies and their categorical approach: rare case series. J Surg Case Rep 2022; 2022:rjac310. [PMID: 35794994 PMCID: PMC9252329 DOI: 10.1093/jscr/rjac310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
The incidence of coronary artery anomalies (CAAs) is 0.2–1.2% of the population. Its paradox of being a rare entity with presentation ranging from sudden cardiac death, congestive heart failure, myocardial infarction to being clinically silent, asserts a challenge to its treating physician. Among the various major categories of CAA, we describe four different types of these anomalies in our retrospective evaluation over 2 years. They include – coronary cameral fistula with coronary aneurysm, congenital atresia of left main, anomalous aortic origin of left anterior descending (LAD) and circumflex artery (LCx) with malignant LAD course, anomalous origin of left coronary artery from pulmonary artery (ALCAPA). Although the child with ALCAPA succumbed despite every possible and available timely efforts, other patients had good postoperative recovery and a brief hospital stay.
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Affiliation(s)
- Krishnaprasad Bashyal
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Bhagawan Koirala
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Anil Bhattarai
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Ravi Kumar Baral
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Prabhat Khakural
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Samir Shakya
- Department of Pediatric Cardiology , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
| | - Prashiddha Bikram Kadel
- Department of Cardiac Surgery , Manmohan Cardiothoracic Vascular and Transplant Center, TUTH, Kathmandu, Nepal
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21
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Vukomanovic D, Unzek S, Reichert W, Mookadam F. Multiple symptomatic giant coronary aneurysms. Clin Case Rep 2022; 10:e05701. [PMID: 35414917 PMCID: PMC8980956 DOI: 10.1002/ccr3.5701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/06/2022] [Accepted: 03/19/2022] [Indexed: 11/25/2022] Open
Abstract
We describe a rare case of coronary artery aneurysms due to Kawasaki disease in an elderly patient. Our case presents multiple giant coronary artery aneurysms affecting the left coronary system which is less common compared with right coronary aneurysms. Giant coronary artery aneurysms are uncommon; even more rare is their association with ischemic symptoms, and treatment can be challenging. We describe a case of symptomatic multiple coronary artery aneurysms with symptom relief after coronary artery bypass grafting in an elderly patient.
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Affiliation(s)
| | - Samuel Unzek
- The University of Arizona College of MedicinePhoenixArizonaUSA
| | | | - Farouk Mookadam
- The University of Arizona College of MedicinePhoenixArizonaUSA
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22
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Esposito L, Di Maio M, Silverio A, Cancro FP, Bellino M, Attisano T, Tarantino FF, Esposito G, Vecchione C, Galasso G, Baldi C. Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma. Front Cardiovasc Med 2022; 8:805727. [PMID: 35187112 PMCID: PMC8854288 DOI: 10.3389/fcvm.2021.805727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/27/2021] [Indexed: 12/19/2022] Open
Abstract
Coronary artery ectasia (CAE) is defined as a diffuse or focal dilation of an epicardial coronary artery, which diameter exceeds by at least 1. 5 times the normal adjacent segment. The term ectasia refers to a diffuse dilation, involving more than 50% of the length of the vessel, while the term aneurysm defines a focal vessel dilation. CAE is a relatively uncommon angiographic finding and its prevalence ranges between 0.3 and 5% of patients undergoing coronary angiography. Although its pathophysiology is still unclear, atherosclerosis seems to be the underlying mechanism in most cases. The prognostic role of CAE is also controversial, but previous studies reported a high risk of cardiovascular events and mortality in these patients after percutaneous coronary intervention. Despite the availability of different options for the interventional management of patients with CAE, including covered stent implantation and stent-assisted coil embolization, there is no one standard approach, as therapy is tailored to the individual patient. The abnormal coronary dilation, often associated with high thrombus burden in the setting of acute coronary syndromes, makes the interventional treatment of CAE patients challenging and often complicated by distal thrombus embolization and stent malapposition. Moreover, the optimal antithrombotic therapy is debated and includes dual antiplatelet therapy, anticoagulation, or a combination of them. In this review we aimed to provide an overview of the pathophysiology, classification, clinical presentation, natural history, and management of patients with CAE, with a focus on the challenges for both clinical and interventional cardiologists in daily clinical practice.
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Affiliation(s)
- Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- *Correspondence: Luca Esposito
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Tiziana Attisano
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Vascular Pathophysiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Cesare Baldi
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
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23
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Tzimas G, Gulsin GS, Takagi H, Mileva N, Sonck J, Muller O, Leipsic JA, Collet C. Coronary CT Angiography to Guide Percutaneous Coronary Intervention. Radiol Cardiothorac Imaging 2022; 4:e210171. [PMID: 35782760 PMCID: PMC8893214 DOI: 10.1148/ryct.210171] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 05/03/2023]
Abstract
Coronary CT angiography (CCTA) has emerged as a powerful noninvasive tool for characterizing the presence, extent, and severity of coronary artery disease (CAD) in patients with stable angina. Recent technological advancements in CT scanner hardware and software have augmented the rich information that can be derived from a single CCTA study. Beyond merely identifying the presence of CAD and assessing stenosis severity, CCTA now allows for the identification and characterization of plaques, lesion length, and fluoroscopic angle optimization, as well as enables the assessment of the physiologic extent of stenosis through CT-derived fractional flow reserve, and may even allow for the prediction of the response to revascularization. These and other features make CCTA capable of not only guiding invasive coronary angiography referral, but also give it the unique ability to help plan coronary intervention. This review summarizes current and future applications of CCTA in procedural planning for percutaneous coronary intervention, provides rationale for wider integration of CCTA in the workflow of the interventional cardiologist, and details how CCTA may help improve patient care and clinical outcomes. Keywords: CT Angiography © RSNA, 2022.
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Affiliation(s)
- Georgios Tzimas
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Gaurav S. Gulsin
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Hidenobu Takagi
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Niya Mileva
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Jeroen Sonck
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Olivier Muller
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Jonathon A. Leipsic
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
| | - Carlos Collet
- From the Department of Medicine and Radiology, University of British
Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z4 (G.T., G.S.G., H.T.,
J.A.L.); Department of Heart Vessels, Cardiology Service, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland (G.T., O.M.);
University of Leicester and the Leicester NIHR Biomedical Research Centre,
Department of Cardiovascular Sciences, Glenfield Hospital, Leicester, England
(G.S.G.); Department of Diagnostic Radiology, Tohoku University Hospital,
Sendai, Japan (H.T.); Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
(N.M., J.S., C.C.); and Department of Advanced Biomedical Sciences, Federico II
University, Naples, Italy (J.S.)
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24
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Fujii T, Mutsuga M, Narita Y, Tokuda Y, Terazawa S, Ito H, Uchida W, Yuhara S, Usui A. Multiple giant coronary artery aneurysms with extended coronary ectasia emerging 12 years after previous coronary artery bypass grafting. SAGE Open Med Case Rep 2022; 10:2050313X221116681. [PMID: 35958880 PMCID: PMC9358548 DOI: 10.1177/2050313x221116681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
A 73-year-old man presented with multiple giant coronary artery aneurysms. Twelve years prior to the presentation, he had undergone coronary artery bypass grafting. At that time, he exhibited small aneurysms (16 mm diameter) in the right coronary artery and a single aneurysm (10 mm diameter) in the left circumflex artery. During follow-up, the aneurysms gradually increased in size (to 45 and 30 mm, respectively, at 12 years after surgery). We resected all of the aneurysms and performed coronary artery bypass grafting of the left circumflex artery through re-sternotomy.
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Affiliation(s)
- Taro Fujii
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuji Narita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sachie Terazawa
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ito
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wataru Uchida
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Yuhara
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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25
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Characteristics and outcomes of patients with coronary artery ectasia presenting with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:82-89. [PMID: 34887205 DOI: 10.1016/j.carrev.2021.11.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND The clinical significance of coronary artery ectasia (CAE) is not yet fully understood. We aimed to examine differences in clinical and procedural characteristics, clinical management, and outcomes in patients with CAE undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). METHODS This was a retrospective analysis of consecutive patients presenting with STEMI with a culprit native coronary artery from July 2015 to June 2019. Patients were divided into CAE and Non-CAE groups as detected on coronary angiography during PPCI. Comparison between groups was made for baseline clinical and procedural characteristics, as well as complications, pharmacological treatment, and follow-up outcomes. RESULTS 36/1780 (2.0%) patients were found to have CAE. Patients with CAE had a median age of 57.1 ± 11.7 years and were more likely to be male 33/36 (91.7%). Diabetes was less commonly seen in the CAE group (11.1% vs 31.4%, p = 0.010), and there were no differences in the proportion of patients with hypertension and hyperlipidemia. Patients with CAE had more involvement of right coronary artery (RCA) culprit vessel (63.9% vs. 38.4%, p = 0.026), less coronary stenting (25.0% vs 87.2%, p < 0.001) and post-PPCI TIMI 3 flow (69.4% vs 95.5%, P < 0.001), and were more likely to be discharged with oral anticoagulants (36.1% vs 7.6%, p < 0.001). At 3-year follow-up, all-cause mortality rates were higher in the non-CAE group (0.0% vs 11.5%, p < 0.028), suggesting that CAE was not associated with unfavorable long-term outcome. On multivariate analysis, CAE was not an independent predictor of MACE. CONCLUSION Despite lower rates of post-PPCI TIMI 3 flow, CAE was not associated with unfavorable long-term outcome.
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26
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Ghetti G, Minnucci M, Chietera F, Donati F, Gagliardi C, Bruno AG, Orzalkiewicz M, Nardi E, Palmerini T, Saia F, Marrozzini C, Galié N, Taglieri N. Sino-tubular junction to sinuses of Valsalva ratio: An echocardiographic parameter to predict coronary artery ectasia in patients with aortic enlargement. Int J Cardiol 2021; 344:226-229. [PMID: 34655674 DOI: 10.1016/j.ijcard.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Coronary artery ectasia (CAE) is associated with ascending aortic (AA) ectasia. The purpose of this study is to evaluate the diagnostic performance of different echocardiographic parameters (EP) in predicting the presence of CAE. METHODS Four hundred-eighteen patients with AA ectasia candidate to coronary angiography were identified and divided in two groups in respect of the presence of CAE. Receiver-operating characteristic curves areas (AUC) were used to assess the discrimination power of the following EP: aortic annulus diameter, sinuses of Valsalva (SV) diameter, sino-tubular junction (STJ) diameter, AA diameter, STJ to SV ratio (STJ-to-SV) and STJ to AA ratio (STJ-to-AA). All these parameters were indexed by body surface area. The relationship between the best EP and the presence of CAE was investigated by means of multivariable logistic regression. RESULTS The rate of CAE in the study population was 32%. On univariable logistic regression, aortic annulus, STJ, STJ-to-SV and STJ-to-AA were associated with the presence of CAE after Bonferroni correction. STJ-to-SV emerged as the parameter with the best discrimination power (AUC = 0.81) compared to STJ (AUC = 0.69), STJ-to-AA (AUC = 0.68), aortic annulus (AUC = 0.59), AA (AUC = 0.56) and SV (AUC = 0.55); (p for comparison <0.01). An 89.6% value for STJ-to-SV ratio emerged as the best cut-off to diagnose CAE with a sensitivity = 75%, specificity = 82%, positive predictive value = 66% and negative predictive value = 88%. On multivariable analysis, STJ-to-SV was still associated with the presence of CAE (OR = 1.15;95%CI:1.11-1.19;p < 0.01). CONCLUSION In patients with dilated aorta, STJ-to-SV sampled by transthoracic echocardiography shows a good diagnostic performance in predicting the presence of CAE.
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Affiliation(s)
- Gabriele Ghetti
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy.
| | - Matteo Minnucci
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Francesco Chietera
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Francesco Donati
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Christian Gagliardi
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Antonio Giulio Bruno
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Mateusz Orzalkiewicz
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Elena Nardi
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Tullio Palmerini
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Francesco Saia
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Cinzia Marrozzini
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Nazzareno Galié
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
| | - Nevio Taglieri
- Istituto di Cardiologia, Università di Bologna, IRCCS Policlinicodi S. Orsola, Via G. Massarenti 9, 40138 Bologna, Italy
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27
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Matta AG, Yaacoub N, Nader V, Moussallem N, Carrie D, Roncalli J. Coronary artery aneurysm: A review. World J Cardiol 2021; 13:446-455. [PMID: 34621489 PMCID: PMC8462041 DOI: 10.4330/wjc.v13.i9.446] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/09/2021] [Accepted: 07/29/2021] [Indexed: 02/06/2023] Open
Abstract
Coronary artery aneurysm (CAA) is a clinical entity defined by a focal enlargement of the coronary artery exceeding the 1.5-fold diameter of the adjacent normal segment. Atherosclerosis is the main cause in adults and Kawasaki disease in children. CAA is a silent progressive disorder incidentally detected by coronary angiography, but it may end with fatal complications such as rupture, compression of adjacent cardiopulmonary structures, thrombus formation and distal embolization. The pathophysiological mechanisms are not well understood. Atherosclerosis, proteolytic imbalance and inflammatory reaction are involved in aneurysmal formation. Data from previously published studies are scarce and controversial, thereby the management of CAA is individualized depending on clinical presentation, CAA characteristics, patient profile and physician experience. Multiple therapeutic approaches including medical treatment, covered stent angioplasty, coil insertion and surgery were described. Herein, we provide an up-to-date systematic review on the pathophysiology, complications and management of CAA.
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Affiliation(s)
- Anthony Georges Matta
- Department of Cardiology, Toulouse University Hospital, Rangueil, Toulouse 31400, France
| | - Nabil Yaacoub
- Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh 961, Lebanon
| | - Vanessa Nader
- Department of Cardiology, Toulouse University Hospital, Rangueil, Toulouse 31400, France
| | - Nicolas Moussallem
- Division of Cardiology, Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh 961, Lebanon
| | - Didier Carrie
- Department of Cardiology, University Hospital Rangueil, Toulouse 31059, France
| | - Jerome Roncalli
- Department of Cardiology, University Hospital of Toulouse/Institute Cardiomet, Toulouse 31400, France.
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28
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Siripornpitak S, Sriprachyakul A, Promphan W, Mokarapong P, Wanitkun S. Coronary artery changes in congenital coronary-cameral fistulas evaluated by computed tomographic angiography. Jpn J Radiol 2021; 39:1149-1158. [PMID: 34181176 DOI: 10.1007/s11604-021-01164-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The study sought to determine coronary artery diameter in congenital coronary-cameral fistula (cCCF), factors associated with coronary artery aneurysm, coronary artery changes after fistula closure, and computed tomographic (CT) findings after treatment. MATERIALS AND METHODS We retrospectively reviewed CT findings of the cCCF for origins, terminations, fistula length, complexities, and Sakakibara classification. Coronary artery diameter was expressed as coronary artery Z score. Fistula features associated with coronary artery aneurysm were analyzed. Post-fistula closures were analyzed for coronary artery dilatation, coronary thrombosis, complete fistula closure, and fistula thrombosis. RESULTS Twenty-five patients (median age 33 months, interquartile range, IQR 25-48) were included. Coronary feeders and terminations were frequently right coronary artery (48%) and right ventricle (56%), respectively. Fistula aneurysm occurred in 52% of cases. Mean coronary artery Z score was 13.03 ± 6.36 with a high incidence of giant coronary artery aneurysm (68%). We found no statistically significant risk factors associated with coronary artery aneurysm (p value range 0.075-0.370). Median duration of the follow-up CT after closure of the fistulas was 6.4 months (IQR 5.0-8.7). Coronary artery Z score significantly decreased by 0.82 (IQR 0.28-1.35), p = 0.006 and coronary thrombosis occurred in 23% of cases during follow-up. CONCLUSIONS Large coronary aneurysm is common in cCCF. No characteristic feature of the fistula influencing coronary artery aneurysm is identified. There is a diminution in coronary artery Z score after fistula closure. Coronary thrombosis is a major complication after treatment.
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Affiliation(s)
- Suvipaporn Siripornpitak
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand. .,Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Apichaya Sriprachyakul
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.,Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand
| | - Worakan Promphan
- Department of Pediatrics, Queen Sirikit National Institute of Child Health, Rangsit University, 420/8 Phayatai Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Pirapat Mokarapong
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Institute of Cardiovascular Diseases, Rajavithi Hospital, 2 Phayatai Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suthep Wanitkun
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand.,Division of Cardiology, Department of Pediatrics, Mahidol University, 270 Rama 6 Road, Phayatai, Ratchathewi, Bangkok, 10400, Thailand
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29
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Chmiel J, Malinowski KP, Książek KM, Wnuk G, Dradrach J, Proniewska K, Partyka Ł, Rosenfield K, Musiałek P. Three-dimensional reconstruction of conventional catheter angiography-identified coronary artery aneurysms and ectasias. Cardiol J 2021; 28:623-626. [PMID: 33843038 DOI: 10.5603/cj.a2021.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/30/2020] [Accepted: 01/17/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jakub Chmiel
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
| | - Krzysztof Piotr Malinowski
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,KCRI Angiographic Corelab and Division of Statistics, Krakow, Poland
| | - Kacper Miłosz Książek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Grażyna Wnuk
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Jagoda Dradrach
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | - Klaudia Proniewska
- Jagiellonian University Medical College, Department of Bioinformatics and Telemedicine, Krakow, Poland
| | - Łukasz Partyka
- KCRI Angiographic Corelab and Division of Statistics, Krakow, Poland
| | - Kenneth Rosenfield
- Department of Cardiology, Massachusetts General Hospital, Boston, United States
| | - Piotr Musiałek
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
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30
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Kumar P, Bhatia M. Coronary Artery Disease Reporting and Data System: A Comprehensive Review. J Cardiovasc Imaging 2021; 30:1-24. [PMID: 34080334 PMCID: PMC8792723 DOI: 10.4250/jcvi.2020.0195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 11/25/2022] Open
Abstract
The Coronary Artery Disease Reporting and Data System (CAD-RADS) is a standardized reporting method for coronary computed tomography angiography (CCTA). It summarizes the findings of CCTA in 6 categories ranging from CAD-RADS 0 (complete absence of coronary artery disease) to CAD-RADS 5 (total occlusion of at least one vessel). It is applied on per patient basis for the highest grade of the stenotic lesion. The CAD-RADS also provides category-specific treatment recommendations, helping patient management. The main objectives of the CAD-RADS are to improve the consistency in reporting, facilitate the communication between interpreting and referring clinicians, recommend the best course of patient management, and produce consistent data for quality improvement, research and education. However, CAD-RADS has many limitations, resulting into the misclassification of the observed findings, misinterpretation of the final category, and misguidance for the treatment based upon the single score. In this review, the authors discuss the CAD-RADS categories and modifiers, along with the strengths and limitations of this new classification system.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India.
| | - Mona Bhatia
- Department of Radiodiagnosis & Imaging, Fortis Escort Heart Institute, New Delhi, India.,Cardiac Imaging, Cardiological Society of India, Kolkata, India.,International Regional Committee, India Chapter, Society of Cardiovascular Computed Tomography, Arlington, VA, USA
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31
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Ben Abderrahim S, Gharbaoui M, Zaara MA, Rammeh-Rommani S, Hamdoun M, Ben Khelil M. Fatal coronary ectasia: An autopsy case report and review of literature. J Forensic Leg Med 2021; 79:102132. [PMID: 33667793 DOI: 10.1016/j.jflm.2021.102132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 11/29/2022]
Abstract
Coronary ectasia is a rare vessel defect that represents a pathological and incidental finding in routine coronary angiography performed for other coronary syndromes. This defect exposes to the risk of intra-coronary thrombosis by blood stasis due to the turbulent blood flow in those dilated areas that can lead to sudden death. We report an autopsy case of a male subject suddenly deceased. A medico-legal autopsy concluded an ischemic heart failure due to a vascular thrombosis by a blood clot in a coronary ectasia. Our case report aimed to discuss the mechanisms of sudden death attributed to coronary artery ectasia.
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Affiliation(s)
- Sarra Ben Abderrahim
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Forensic Medicine, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia
| | - Meriem Gharbaoui
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Forensic Medicine, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia
| | - Mohamed Amine Zaara
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Forensic Medicine, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia
| | - Soumaya Rammeh-Rommani
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Pathological Anatomy and Cytology, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia
| | - Moncef Hamdoun
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Forensic Medicine, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia
| | - Mehdi Ben Khelil
- Tunis Faculty of Medicine, University of Tunis El Manar, Djebel Lakhdhar Street, La Rabta, 1007, Tunis, Tunisia; Department of Forensic Medicine, Charles Nicolle University Hospital, 138, Boulevard 9 Avril 1938, 1006, Tunis, Tunisia.
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32
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Characteristics and Outcomes of Coronary Artery Involvement in Polyarteritis Nodosa. Can J Cardiol 2020; 37:895-903. [PMID: 33310144 DOI: 10.1016/j.cjca.2020.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/03/2020] [Accepted: 11/18/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Coronary artery involvement is a severe but uncommon manifestation of polyarteritis nodosa (PAN), so clinicians have little knowledge of it. Our aim was to investigate the clinical characteristics, risk factors and outcomes of patients with PAN complicated with coronary artery lesions. METHODS Data from 145 patients with PAN who were admitted to Peking Union Medical College Hospital from January 2000 to September 2019 were retrospectively collected. RESULTS Nineteen patients (13.1%) had coronary artery lesions due to PAN. The age at the onset of PAN was 32.3 ± 11.8 years. There were no significant differences in common risk factors for coronary arterial atherosclerosis between the patients with coronary artery involvement and those without. Affected branches of the coronary arteries were left anterior descending branch (15 patients), right coronary artery (14 patients), and left circumflex branch (9 patients). Eleven of the 19 patients exhibited multivessel lesions. Multivariate logistic regression analysis showed that celiac artery involvement (odds ratio [OR] 3.722, 95% confidence interval [CI] 1.115-12.427; P = 0.033) and new-onset hypertension (OR 6.668, 95% CI 1.936-22.961; P = 0.003) were risk factors for coronary artery involvement in patients with PAN. Stent placement was performed for 2 patients, and in-stent restenosis occurred in 1 of those patients a year later. CONCLUSIONS PAN with coronary artery involvement exhibits more combined involvement of arteries of other organs and more severe diseases. PAN should be considered when treating young adults with an unknown origin of coronary artery lesions. In addition to systemic immunosuppressive treatment, other measures including antiplatelet and anticoagulation therapy should be initiated; however, determining the optimal time to perform procedures such as intervention or surgery is still challenging.
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33
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Percutaneous Coronary Intervention in Coronary Artery Aneurysms; Technical Aspects. Report of Case Series and Literature Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28S:243-248. [PMID: 33323331 DOI: 10.1016/j.carrev.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/15/2020] [Accepted: 12/04/2020] [Indexed: 12/20/2022]
Abstract
Coronary Artery Aneurysms (CAAs) in both symptomatic and asymptomatic patients are associated with poor long-term outcomes. The best treatment option for CAAs remains a subject of debate. The underlying pathology is not well understood, randomised controlled trials and supportive data are lacking and there is no consensus on treatment plan. The recommended therapies include medical management, percutaneous or surgical exclusion of the aneurysm or coronary artery bypass grafting surgery (CABG). Percutaneous coronary intervention (PCI) can be technically challenging even with a suitable anatomy, specifically in acute coronary syndrome (ACS). We report case series of CAAs presenting as ACS and focus on PCI treatment option.
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34
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Jaglan A, Ajam T, Port SC, Bajwa T, Tajik AJ. A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33628993 PMCID: PMC7891237 DOI: 10.1093/ehjcr/ytaa274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/24/2020] [Accepted: 07/22/2020] [Indexed: 11/24/2022]
Abstract
Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.
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Affiliation(s)
- Akshar Jaglan
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Tarek Ajam
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Steven C Port
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - Tanvir Bajwa
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
| | - A Jamil Tajik
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI 53215, USA
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35
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Wei W, Wang X, Huang Z, Li X, Luo Y. Difference in inflammation, atherosclerosis, and platelet activation between coronary artery aneurysm and coronary artery ectasia. J Thorac Dis 2020; 12:5811-5821. [PMID: 33209413 PMCID: PMC7656333 DOI: 10.21037/jtd-20-1579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Coronary artery aneurysm (CAA) and coronary artery ectasia (CAE) may be two different types of coronary artery dilatation with unknown etiology. This study aimed to compare the differences between CAA and CAE and to investigate their pathogenesis and the necessity of antiplatelet therapy. Methods One hundred patients each with confirmed CAA, CAE, and normal coronary artery (NCA) from September 2017 to July 2019 were included. All patients completed examinations of the ankle-brachial index (ABI), pulse wave rate, and carotid ultrasonography; and were tested for routine blood, lipid, and immune parameters. Blood samples were collected 1 week after the withdrawal of antiplatelet drugs, and vascular inflammatory indexes, platelet activation indexes, thromboelastography, and the platelet aggregation rate were measured. Analysis of variance and the chi-square or Fisher exact test were used for statistical analysis. Results The perinuclear anti-neutrophil cytoplasmic antibody (ANCA), endothelial-1, matrix metalloproteinase-9, and tumor necrosis factor-α were significantly higher in CAE than in NCA, while cytoplasmic ANCA was appreciably higher in CAE than in CAA (P<0.05). Myeloperoxidase and growth/differentiation factor-15 were significantly higher in CAE than in CAA and NCA (P<0.05). ABI was significantly lower in CAA and CAE than in NCA (P<0.05), low-density lipoprotein/high-density lipoprotein was significantly higher in CAA than in NCA (P<0.05), and the detection rate of carotid artery thickening was significantly higher in CAA than in CAE and NCA (P<0.05). The Gensini and SYNTAX scores were significantly higher in CAA than in CAE (P<0.05). The percentages of CD62P and PAC-1 were higher in CAA and CAE than in NCA (P<0.05). The arachidonic acid aggregation rate in CAA and adenosine 5'-diphosphate aggregation rate in CAE were significantly higher than in NCA (P<0.05). The values of thrombin formation time and reaction time were significantly lower in CAE than in NCA (P<0.05), and the α angle was significantly higher in CAE than in NCA. Conclusions CAE was closely related to inflammation, whereas CAA was closely related to atherosclerosis. Platelet activation was present in both diseases; therefore, antiplatelet therapy is recommended.
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Affiliation(s)
- Wei Wei
- Department of Cardiovascular Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xingxu Wang
- Department of Cardiovascular Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhenghao Huang
- Department of Cardiovascular Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaolin Li
- Department of Cardiovascular Medicine, Jian East Hospital, Jinggangshan University School of Medicine, Jiangxi, China
| | - Yu Luo
- Department of Cardiovascular Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China
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Valente T, Pignatiello M, Sica G, Bocchini G, Rea G, Cappabianca S, Scaglione M. Hemopericardium in the acute clinical setting: Are we ready for a tailored management approach on the basis of MDCT findings? LA RADIOLOGIA MEDICA 2020; 126:527-543. [PMID: 33136215 DOI: 10.1007/s11547-020-01303-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
The clinical spectrum of pericardial effusions varies from innocuous serous fluid to life-threatening hemopericardium. A misdiagnosis may be made by similar clinical presentation of acute chest pain/hypotension. Echocardiography is the first-line test for diagnosis of pericardial effusion and its etiology, but sometimes there are different drawbacks to the correct cardiovascular ultrasound diagnosis. Radiologists are reporting an increasing amount of thoracic Multidetector CT examinations at the emergency department. Multidetector CT has now become an established and complementary method for cardiac imaging, and diseases of the pericardium can now be quickly identified with increasing certainty. The aim of this review is to discuss the hemopericardium key Multidetector CT features in acute clinical setting which indicate the need to proceed with predominantly medical or surgical treatment, however, being able to identify forms of bleeding pericardial effusion for which only "a watch and wait strategy" and/or deferred treatment is indicated. In the emergency care setting, radiologists must be aware of different findings of hemopericardium in order to address a tailored and timely management approach.
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Affiliation(s)
- Tullio Valente
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy.
| | - Maria Pignatiello
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Giacomo Sica
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Giorgio Bocchini
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Gaetano Rea
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Monaldi Hospital, Via Leonardo Bianchi, Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Mariano Scaglione
- Department of Diagnostic Imaging, Pineta Grande Hospital, Castelvolturno, Italy
- Department of Radiology, Tesside University, Middlesbrough, UK
- James Cook University Hospital, Middlesbrough, UK
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37
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von Hafe P, Dias G, Cardoso F, Oliveira M, Lopes RL, Leite S. Giant right coronary aneurysm: a coronary CT angiography exhibited severe aneurysmatic dilation of the right coronary artery. Int J Cardiovasc Imaging 2020; 37:1093-1095. [PMID: 33085028 DOI: 10.1007/s10554-020-02076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Geraldo Dias
- Senhora da Oliveira Hospital, Creixomil, Portugal
| | | | | | - Ricardo Ladeiras Lopes
- Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal.,Universidade do Porto, Porto, Portugal
| | - Sérgio Leite
- Senhora da Oliveira Hospital, Creixomil, Portugal
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38
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Zhu X, Zhou Q, Tong S, Zhou Y. Challenges and strategies in the management of coronary artery aneurysms. Hellenic J Cardiol 2020; 62:112-120. [PMID: 32937198 DOI: 10.1016/j.hjc.2020.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 11/27/2022] Open
Abstract
Coronary artery aneurysms (CAAs) are infrequent but not rare. Because of the lack of supportive data and a substantial knowledge gap in this field, clinicians are in a dilemma how to manage patients with coronary artery aneurysms. Most often, CAAs are discovered incidentally, while symptomatic patients present with diverse complications of unstable angina, myocardial infarction, arrhythmias, or sudden cardiac death. Therapeutical approaches consist of surgical procedure, percutaneous coronary intervention (PCI), and medical management. Because of the scarcity of randomized trials or large-scale data on symptomatic and asymptomatic patients with coronary artery aneurysms, the management of these patients poses considerable challenges for the cardiologists. This review summarizes the current literature, a proposed algorithm for the management of CAAs is highlighted in the text. In view of the majority of current proposal information based on small series of case reports or observational studies, an individualized therapeutic regimen should be on the basis of the location, expansion by time, morphology, complications, and etiologies of the coronary artery aneurysms, the clinical presentations, and the patient's characteristics.
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Affiliation(s)
- Xiaogang Zhu
- Department of Cardiology, 12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China; Department of Cardiology, Fu Xing Hospital, Capital Medical University, Beijing 100038, China
| | - Quanzhong Zhou
- Department of Radiology, The Center for Medical Imaging of Guizhou Province, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi, Guizhou Province, 563000, China
| | - Shan Tong
- Department of Cardiology, 12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China
| | - Yujie Zhou
- Department of Cardiology, 12th Ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing 100029, China.
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Kassab K, Iskander M, Malhotra S, Pyslar N. Delineating anatomy and function with multimodality imaging: a case report of giant right coronary artery aneurysms. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32617482 PMCID: PMC7319827 DOI: 10.1093/ehjcr/ytaa089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/09/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Abstract
Background Giant coronary artery aneurysms (CAAs) are rare and have been reported in patients with connective tissue diseases, arteritides, and atherosclerosis. Given the rarity of the condition, multimodality imaging is essential for comprehensive evaluation of coronary aneurysms and determination of their haemodynamic significance. Case summary A 58-year-old Filipino female was evaluated for dyspnoea on exertion of one month. Chest computed tomography (CT) showed right coronary artery (RCA) aneurysms. Invasive coronary angiogram (ICA) confirmed two giant aneurysms of the RCA. Distal RCA could not be opacified due to contrast stagnation in the proximal aneurysms. Coronary CT angiography (CCTA) depicted an additional giant distal RCA aneurysm not visualized on ICA with intraluminal thrombosis. Contrast-enhanced cardiac magnetic resonance imaging (CMR) revealed delayed time to peak perfusion in the mid to apical inferior walls, on first-pass imaging, without myocardial scarring. Late gadolinium images revealed aneurysmal wall inflammation. Discussion This case highlights the anatomical findings of giant CAA and the application of multimodality imaging for their accurate characterization. While ICA confirmed the presence of the aneurysms, CCTA enabled the assessment of their full extent and depict intraluminal thrombosis. Contrast-enhanced CMR delineated aneurysm wall characteristics, with first-pass images demonstrating reduced inferior wall perfusion at rest, which was likely the cause of patient’s exertional symptoms. Management of giant coronary aneurysms involves surgical resection with bypass grafting.
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Affiliation(s)
- Kameel Kassab
- Division of Cardiology, Department of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, Room 3620, Chicago, IL 60612, USA
| | - Mina Iskander
- Division of Cardiology, Department of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, Room 3620, Chicago, IL 60612, USA
| | - Saurabh Malhotra
- Division of Cardiology, Department of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, Room 3620, Chicago, IL 60612, USA
| | - Nataliya Pyslar
- Division of Cardiology, Department of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, Room 3620, Chicago, IL 60612, USA
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40
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Tien TQ. Double giant ectasia of right coronary artery in a young woman: A rare case report. Int J Surg Case Rep 2020; 71:112-115. [PMID: 32446988 PMCID: PMC7242977 DOI: 10.1016/j.ijscr.2020.04.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022] Open
Abstract
Giant coronary ectasia is a rare and life-threatening condition. The optimal strategy for the treatment of coronary artery ectasia is debatable. Surgical treatment is a proper method for the giant aneurysmal sacs. Background Coronary artery ectasia (CAE) is a rare condition that is characterized by the excessive diffuse dilatation of the coronary arteries by 1.5 times in diameter compared to adjacent coronary arteries. The giant CAE is even rarer and life-threatening. Case presentation A 34-year-old female patient was admitted to our centre with three months history of vague chest pain that worsened gradually. The CT scanner confirmed that there were two giant aneurysmal sacs in the right coronary artery (RCA). The first sac was 32 × 36 mm in size and located in the proximal RCA, the second one containing thrombus in the middle RCA with a size of 43 × 30 mm. The patient was successfully treated by aneurysmal resection and concomitant coronary artery bypass. Conclusion Giant coronary artery ectasia is a rare clinical condition and very dangerous for patients unless properly treated. We successfully treated a case of giant right coronary artery ectasia with favorable outcome.
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Affiliation(s)
- Tran Quyet Tien
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh City 72714, Viet Nam; Cardiovascular Center of Cho Ray Hospital, 201B Nguyen Chi Thanh Street, District 5, Ho Chi Minh City 72714, Viet Nam.
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41
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Malyshev Y, Syed A, Castillo R, Syed RA, Sahni S. Giant Left Main Coronary Artery Aneurysm Presenting as Multiple Implantable Cardioverter Defibrillator Shocks. Cureus 2020; 12:e7653. [PMID: 32411554 PMCID: PMC7217590 DOI: 10.7759/cureus.7653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Giant aneurysms of the left main coronary artery are one of the rarest findings in cardiology, encountered in less than 0.02% of patients. The presentation is usually the same as coronary artery disease since most coronary aneurysms in the western world are associated with atherosclerosis. Here we report the first case of giant aneurysm of the left main coronary artery presenting as ventricular tachycardia with multiple shocks of the defibrillator in a 57-year-old man with heart failure. We also review the etiology, pathology, and management of coronary aneurysms.
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Affiliation(s)
- Yury Malyshev
- Cardiology, Maimonides Medical Center, Brooklyn, USA
| | - Asma Syed
- Cardiology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Ricardo Castillo
- Cardiology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Rumman A Syed
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Sonu Sahni
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA.,Research Medicine, New York Institute of Technology College of Osteopathic Medicine, New York, USA.,Primary Care, Touro College of Osteopathic Medicine, New York, USA
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42
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Canan A, Ranganath P, Goerne H, Abbara S, Landeras L, Rajiah P. CAD-RADS: Pushing the Limits. Radiographics 2020; 40:629-652. [PMID: 32281902 DOI: 10.1148/rg.2020190164] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Coronary CT angiography is now established as the first-line diagnostic imaging test to exclude coronary artery disease (CAD) in the population at low to intermediate risk. Wide variability exists in both the reporting of coronary CT angiography and the interpretation of these reports by referring physicians. The CAD Reporting and Data System (CAD-RADS) is sponsored by multiple societies and is a collaborative effort to provide standard classification of CAD, which is then integrated into patient clinical care. The main goals of the CAD-RADS are to decrease variability among readers; enhance communication between interpreting and referring clinicians, allowing collaborative determination of the best course of patient care; and generate consistent data for auditing, data mining, quality improvement, research, and education. There are several scenarios in which the CAD-RADS guidelines are ambiguous or do not provide definite recommendations for further management of CAD. The authors discuss the CAD-RADS categories and modifiers, highlight a variety of complex or ambiguous scenarios, and provide recommendations for managing these scenarios. Online supplemental material is available for this article. ©RSNA, 2020 See discussion on this article by Aviram and Wolak.
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Affiliation(s)
- Arzu Canan
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Praveen Ranganath
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Harold Goerne
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Suhny Abbara
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Luis Landeras
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Tex (A.C., P. Ranganath, H.G., S.A., P. Rajiah); Imaging and Diagnosis Center, Guadalajara, Mexico (H.G.); and Department of Radiology, University of Chicago Medical Center, Chicago, Ill (L.L.)
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43
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Yu Y, Wang QS, Wang XF, Sun J, Yu LW, Ding M, Li YG. Diagnostic value of echocardiography on detecting the various types of anomalous origin of the left coronary artery from the pulmonary artery. J Thorac Dis 2020; 12:319-328. [PMID: 32274098 PMCID: PMC7139093 DOI: 10.21037/jtd.2020.01.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/13/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND To assess the diagnostic value of echocardiography in detecting the various types of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). METHODS A total of 30 patients with an established diagnosis of ALCAPA were retrospectively analyzed, and classified into infant- (n=20) and adult-type (n=10) groups according to the age of symptom manifestation and the mode of presentation. All patients underwent echocardiography examination. RESULTS Twenty-four out of thirty patients were diagnosed with ALCAPA by echocardiography. The remaining six cases were confirmed by dual-source computed tomography (DSCT) and angiocardiography, respectively. In the infant-type group, there was negligible or no collateral flow between the right coronary artery (RCA) and the left coronary artery (LCA). Eighteen of these patients had enhanced echogenicity of left ventricular (LV) papillary muscles, different degrees of mitral regurgitation (MR) and the RCA to aortic annulus ratio (RCA/AO) was >0.12. In the adult-type group, all ten patients had RCA dilation and significant development of collateralization from the RCA to the dilated LCA. They all had mild MR and RCA/AO was >0.20. Preoperatively, left ventricular ejection fraction (LVEF) was significantly lower in infant-type group than in adult-type group (46.24%±5.47% vs. 61.43%±6.38%, P<0.01). Cardiac surgery significantly improved post-operative LVEF (60.12%±6.02%, P<0.01 vs. pre-operation) in infant-type group. CONCLUSIONS Echocardiography plays a pivotal role in detecting ALCAPA. Imaging and clinical features differ significantly between infant- and adult-type cases.
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Affiliation(s)
- Yi Yu
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Qun-Shan Wang
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Xi-Fang Wang
- Department of Performance, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Ling-Wei Yu
- Department of Radiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Ming Ding
- Department of Radiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
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Parikh P, Banerjee K, Sammour Y, Ali AF, Sankaramangalam K, Nair R, Ellis S, Raymond R, Tuzcu EM, Kapadia S. Utilization and outcomes of polytetrafluoroethylene covered stents in patients with coronary artery perforation and coronary artery aneurysm: Single center 15-year experience. Catheter Cardiovasc Interv 2019; 94:555-561. [PMID: 31429192 DOI: 10.1002/ccd.28448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/19/2019] [Accepted: 08/01/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Determine the outcomes of polytetrafluoroethylene (PTFE) covered stents for coronary artery perforation (CAP) and coronary artery aneurysm (CAA). BACKGROUND PTFE covered stents have been used for treatment of potentially life-threatening CAP and CAA. The short and long-term outcomes of the PTFE covered stent for CAP and CAA have not been well studied. METHODS We performed a retrospective study of PTFE covered stents that were placed in the patients from 2003 to 2017. Short term outcomes included in-hospital mortality, pericardial effusion, cardiac tamponade, and length of stay. Long-term outcomes included target lesion revascularization (TLR), in-stent restenosis (ISR), and long-term mortality. RESULTS Fifty-three PTFE covered stents were placed in 32 patients of which there were 24 patients with a CAP with a mean age of 75 ± 8 years. Two patients died in-hospital, with no additional deaths at 30 days. The rate of ISR was 25%, with estimated rates of TLR of 2.6% (3 years) and 17.8% (5 years). The median survival was 55.6 months, with survival at 10 years estimated to be 30.9%. Eight patients received a PTFE covered stent for CAA with a mean age of 59 ± 15 years with no in-hospital or 30-day mortality. Median follow-up of 49 months showed no evidence of TLR. The all-cause mortality was 12% at 1 year and 38% at 3 years. CONCLUSIONS PTFE covered stents is an effective option in patients with CAP and CAA. The long-term outcomes may be related to the pathology of the disease rather than the stent itself.
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Affiliation(s)
- Parth Parikh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yasser Sammour
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ambreen F Ali
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kesavan Sankaramangalam
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ravi Nair
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephen Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Russell Raymond
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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Núñez-Gil IJ, Cerrato E, Bollati M, Nombela-Franco L, Terol B, Alfonso-Rodríguez E, Camacho Freire SJ, Villablanca PA, Amat Santos IJ, de la Torre Hernández JM, Pascual I, Liebetrau C, Camacho B, Pavani M, Albistur J, Latini RA, Varbella F, Jiménez-Díaz VA, Piraino D, Mancone M, Alfonso F, Linares JA, Rodríguez-Olivares R, Jiménez Mazuecos JM, Palazuelos Molinero J, Sánchez-Grande Flecha A, Gomez-Hospital JA, Ielasi A, Lozano Í, Omedè P, Bagur R, Ugo F, Medda M, Louka BF, Kala P, Escaned J, Bautista D, Feltes G, Salinas P, Alkhouli M, Macaya C, Fernández-Ortiz A. Coronary artery aneurysms, insights from the international coronary artery aneurysm registry (CAAR). Int J Cardiol 2019; 299:49-55. [PMID: 31378382 DOI: 10.1016/j.ijcard.2019.05.067] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/13/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3-12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes. METHODS AND RESULTS The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004-2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents. CONCLUSIONS Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.
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Affiliation(s)
- Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Enrico Cerrato
- Interventional Cardiology, Infermi Hospital, Rivoli, Turin, Italy
| | - Mario Bollati
- Interventional Cardiology, Policlinico San Donato, Milan, Italy
| | | | - Belén Terol
- Cardiology Department, Hospital Severo Ochoa, Leganés, Spain
| | | | | | - Pedro A Villablanca
- Interventional Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Ignacio J Amat Santos
- CIBERCV, Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Isaac Pascual
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; University of Oviedo, Oviedo, Spain
| | - Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Benjamín Camacho
- Interventional Cardiology, Hospital Arnau de Vilanova, Lérida, Spain
| | - Marco Pavani
- Cardiology, Città della Salute e della Scienza, Molinnette II, Torino, Italy
| | - Juan Albistur
- Cardiology, Hospital de Clínicas Dr, Manuel Quintela, Montevideo, Uruguay
| | | | | | | | - Davide Piraino
- UO di Cardiologia Interventistica ed Emodinamica, Azienda Ospedaliera Universitaria Policlinico "P,Giaccone" Palermo, Italy
| | - Massimo Mancone
- Is Sapienza University of Rome, Policlinico Umberto I. Department of Cardiovascular, Respiratory, Neurological, Anaesthesiology and Geriatric Sciences
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Alfonso Ielasi
- Cardiology Division, ASST Bergamo Est, Bolognini Hospital Seriate, Italy
| | - Íñigo Lozano
- Interventional Cardiology, Hospital de Cabueñes, Gijon, Spain
| | - Pierluigi Omedè
- Cardiology, Città della Salute e della Scienza, Molinnette I, Torino, Italy
| | - Rodrigo Bagur
- Interventional Cardiology, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Fabrizio Ugo
- Interventional Cardiology, H San Giovanni Bosco, Turin, Italy
| | - Massimo Medda
- Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Boshra F Louka
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, USA
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel Bautista
- Cardiology, Instituto dominicano de Cardiología, Santo Domingo, Dominican Republic
| | - Gisela Feltes
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Pablo Salinas
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Mohamad Alkhouli
- Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States of America
| | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Nikolaidou CN, Vassiliou VS, Watson WD. Coronary artery aneurysms-a truly rare entity or simply unrecognized so far? Oxf Med Case Reports 2019; 2019:omz009. [PMID: 30949347 PMCID: PMC6440257 DOI: 10.1093/omcr/omz009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/15/2019] [Accepted: 02/01/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
| | | | - William D Watson
- Oxford Centre for Magnetic Resonance, University of Oxford, Oxford, UK
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Waqas M, Bizzocchi LL, Menegus MA, Faillace RT. Coronary Artery Ectasia: An Insight into Intraprocedural and Postprocedural Management Strategies. Cureus 2019; 11:e3928. [PMID: 30931196 PMCID: PMC6430305 DOI: 10.7759/cureus.3928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Coronary artery ectasia (CAE) can present as an acute coronary syndrome (ACS) with a high clot burden in ectatic coronary arteries. Thrombectomy with intracoronary thrombolysis often does not ensure immediate blood flow. Also, there have not been clear guidelines regarding long-term management in such cases. A 40-year-old male presented with anginal chest discomfort and a working diagnosis of non-ST elevation myocardial infarction (NSTEMI) was made. The initial angiography showed thrombotic occlusion of several large and ectatic coronary arteries with visibly swirling blood flow. The culprit lesions were treated with balloon angioplasty and multiple rounds of thrombectomy yielding red thrombi. Interestingly, the post-intervention antegrade flow decreased in both vessels (Thrombolysis in Myocardial Infarction (TIMI) score: 0), possibly because of the distal migration of the clots. Peri-procedure, the patient received two boluses of eptifibatide, 180 mcg/kg each, followed by a continuous infusion of 2 mcg/kg/minute for 18 hours. Afterward, the patient was started on ticagrelor and continued on daily aspirin, high-intensity statin, beta blocker, and Coumadin® with heparin bridge. During the one year follow-up period, the Coumadin was switched to rivaroxaban, ticagrelor was stopped after six months, and the patient was continued on guideline-directed medical therapy (GDMT) for coronary artery disease (CAD) with favorable outcomes. The presented case gives us an insight into not only the intra-procedural but also the post-procedural management of ACS in the setting of CAE, and that is thrombectomy alone followed by longer duration oral anticoagulation in addition to GDMT for CAD. However, it will be interesting to see future studies aimed toward defining the duration as well as the choice of anticoagulation, i.e., dual antiplatelet therapy (DAPT) alone or in combination with warfarin/novel oral anticoagulants (NOACs).
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Affiliation(s)
- Muhammad Waqas
- Internal Medicine, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
| | - Lilian L Bizzocchi
- Internal Medicine, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
| | - Mark A Menegus
- Cardiology, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
| | - Robert T Faillace
- Cardiology, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA
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Sheikh AS, Hailan A, Kinnaird T, Choudhury A, Smith D. Coronary Artery Aneurysm: Evaluation, Prognosis, and Proposed Treatment Strategies. Heart Views 2019; 20:101-108. [PMID: 31620255 PMCID: PMC6791093 DOI: 10.4103/heartviews.heartviews_1_19] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Coronary artery aneurysm is a rare disorder, which occurs in 0.3%-4.9% of patients undergoing coronary angiography. Atherosclerosis accounts for >90% of coronary artery aneurysms in adults, whereas Kawasaki disease is responsible for most cases in children. Recently, with the advent of implantation of drug-eluting stents, there are increasing reports suggesting stents causing coronary aneurysms, months or years after the procedure. The pathophysiology of coronary artery aneurysm is not completely understood but is thought to be similar to that for aneurysms of larger vessels, with the destruction of arterial media, thinning of the arterial wall, increased wall stress, and progressive dilatation of the coronary artery segment. Coronary angiography remains the gold standard tool, providing information about the size, shape, and location and is also useful for planning the strategy of surgical resection. The natural history and prognosis remain unclear. Despite the important anatomical abnormality of the coronary artery, the treatment options of coronary artery aneuryms are still poorly defined and present a therapeutic challenge. We describe four cases, which were managed differently followed by a review of the current literature and propose some treatment strategies.
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Affiliation(s)
- Azeem S Sheikh
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Ahmed Hailan
- Department of Cardiology, Morriston Hospital, Swansea, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | | | - David Smith
- Department of Cardiology, Morriston Hospital, Swansea, UK
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Yu Y, Zhou Z, Sun K, Xi L, Zhang L, Yu L, Wang J, Zheng J, Ding M. Association between coronary artery atherosclerosis and plasma glucose levels assessed by dual-source computed tomography. J Thorac Dis 2018; 10:6050-6059. [PMID: 30622776 DOI: 10.21037/jtd.2018.10.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background To assess the association between coronary artery atherosclerosis (CAA) and plasma glucose parameters in a randomly selected cohort of asymptomatic, community-dwelling, Chinese adults by dual-source computed tomography (DSCT). Methods We randomly selected participants and classified them into three groups based on their plasma glucose levels: normal glucose regulation (NGR), pre-diabetes, and diabetes mellitus (DM). The participants underwent DSCT, and those identified with CAA were divided into four groups according to the severity of their coronary artery stenosis. We analyzed the composition of plaques in all coronary artery segments according to the American Heart Association's (AHA) guidelines. We compared the severity of coronary artery stenosis and the plaque composition with plasma glucose parameters among participants. Results Out of a total of 335 participants, 118 were found to have CAA. The prevalence of CAA was highest (P value for trend =0.031) in the diabetic group (67.7%) followed by the pre-diabetic group (35.1%) then the NGR group (27.7%). Both calcified and mixed plaques were found in the coronary arteries of the diabetic group while mixed and non-calcified plaques predominated in the pre-diabetic and the NGR groups. When data from all subjects with CAA were analyzed, blood glucose parameters, fasting plasma glucose (FPG), 2-hr postprandial plasma glucose (PPG), and hemoglobin A1c (HbA1c), exhibited a positive correlation with the severity of coronary stenosis (P<0.05). Multivariable logistic regression models indicated a significantly higher risk of CAA among the diabetic patients. Triglyceride levels were positively correlated with the blood glucose parameters among the three groups while LDL-C was elevated in the DM group but not in the pre-diabetic group compared to the NGR group. Conclusions The severity of CAA exhibited a direct correlation with the blood glucose parameters, FPG, PPG, and HbA1c. DSCT can accurately detect the presence and distribution of CAA in asymptomatic, community-dwelling subjects. DSCT is a useful screening tool for coronary artery disease (CAD).
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Affiliation(s)
- Yi Yu
- Department of Ultrasound, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Zhiwen Zhou
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Kun Sun
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Lili Xi
- Department of Ultrasound, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Lina Zhang
- Department of Biostatistics, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Lingwei Yu
- Department of Radiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jing Wang
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jiayi Zheng
- Department of Cardiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Ming Ding
- Department of Radiology, Xinhua Hospital Affiliated with the School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
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50
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Bouzerda A, Bendriss L, Khatouri A. [Atheromatous coronary ectasia]. Pan Afr Med J 2018; 30:111. [PMID: 30364392 PMCID: PMC6195230 DOI: 10.11604/pamj.2018.30.111.14916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/25/2018] [Indexed: 11/14/2022] Open
Abstract
Les ectasies coronaires sont des pathologies relativement rares et mal connues. Leur étiologie chez l'adulte est le plus souvent athéromateuse. Ces anomalies exposeraient au risque de thrombose intracoronaire par stase sanguine, elles sont le plus souvent associées à des lésions sténosantes qui conditionnent le pronostic. Nous rapportons trois observations de patients hospitalisés pour un syndrome coronarien aigu ST positif avec un aspect de mégacoronaires noté à la coronarographie et nous discutons une revue de la littérature concernant ce type de lésions.
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Affiliation(s)
- Abdelmajid Bouzerda
- Service de Cardiologie, Hôpital Militaire d'Instruction Mohamed V, Rabat, Université Cadi Ayyad, Faculté de Médecine et de Pharmacie, Marrakech, Maroc
| | - Laila Bendriss
- Service de Cardiologie, Hôpital Militaire Avicenne, Université Cadi Ayyad, Faculté de Médecine et de Pharmacie, Marrakech, Maroc
| | - Ali Khatouri
- Service de Cardiologie, Hôpital Militaire Avicenne, Université Cadi Ayyad, Faculté de Médecine et de Pharmacie, Marrakech, Maroc
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