Asymptomatic Giant Aneurysm of the Left Anterior Descending Coronary Artery: A Case Report and Review of the Literature
-
Marija Bjelobrk
,
Slobodan Dodic
,
Tatjana Miljkovic
,
Golub Samardzija
,
Ilija Bjeljac
,
Dragana Dabovic
,
Biljana Dodic
,
Milenko Rosic
,
Mila Kovacevic
,
Aleksandar Redzek
,
Miklos Fabri
Abstract
The most common cause of coronary artery aneurysms is atherosclerosis, which is associated with over 50% of all aneurysms diagnosed in adults. Although patients can be asymptomatic throughout their lives, giant coronary artery aneurysms can manifest themselves as myocardial infarction, aneurysmal rupture, and sudden cardiac death as well. Herein, we describe an asymptomatic patient with numerous risk factors and a positive cardiopulmonary exercise test who was admitted to the cardiology clinic for coronary angiography. A giant coronary artery aneurysm (3.0×2.0 cm in diameter) in the left anterior descending coronary artery and significant stenosis in both left and right coronary arteries were found. After discussing possible treatment options, the hospital’s heart team recommended the surgical resection of the aneurysm and double coronary artery bypass graft. Four years after the cardiac surgery, at the time of writing the current manuscript, the patient is still in good condition and with no symptoms.
1. Pahlavan PS, Niroomand F. Coronary artery aneurysm: a review. Clin Cardiol 2006;29:439-443.
2. Ozeren M, Dogan OV, Dogan S, Yucel E. True and pseudo aneurysms of coronary arteries in a patient with Behçet's disease. Eur J Cardiothorac Surg 2004;25:465-467.
3. Nichols L, Lagana S, Parwani A. Coronary artery aneurysm: a review and hypothesis regarding etiology. Arch Pathol Lab Med 2008;132:823-828.
4. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, Kazue T, Eto G, Yamakawa R. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996;94:1379-1385.
5. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, De Bacquer D, Ducimetière P, Jousilahti P, Keil U, Njølstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel H, Whincup P, Wilhelmsen L, Graham IM, SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987-1003.
6. Morgagni GB. Founders of Modern Medicine: Giovanni Battista Morgagni (1682-1771). Med Library Hist J 1903;1:270-277.
7. Scott DH. Aneurysm of the coronary arteries. Am Heart J 1948;36:403-421.
8. Porcalla AR, Sable CA, Patel KM, Martin GR, Singh N. The epidemiology of Kawasaki disease in an urban hospital: does African American race protect against coronary artery aneurysms?. Pediatr Cardiol 2005;26:775-781.
9. Sharma SN, Kaul U, Sharma S, Wasir HS, Manchanda SC, Bahl VK, Talwar KK, Rajani M, Bhatia ML. Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study. Indian Heart J 1990;42:365-369.
10. Doustkami H, Maleki N, Tavosi Z. Left Main Coronary Artery Aneurysm. J Teh Univ Heart Ctr 2016;11:41-45.
11. Jha NK, Ouda HZ, Khan JA, Eising GP, Augustin N. Giant right coronary artery aneurysm- case report and literature review. J Cardiothorac Surg 2009;4:18.
12. Mata KM, Fernandes CR, Floriano EM, Martins AP, Rossi MA, Ramos SG. Coronary artery aneurysms: an update. In: Lakshmanadoss U, ed. Novel Strategies in Ischemic Heart Disease. Rijeka: InTech; 2012. p. 381–404.
13. Dajani AS, Taubert KA, Gerber MA, Shulman ST, Ferrieri P, Freed M, Takahashi M, Bierman FZ, Karchmer AW, Wilson W. Diagnosis and therapy of Kawasaki disease in children. Circulation 1993;87:1776-1780.
14. Panja M, Sarkar C, Kar AK, Kumar S, Mazumder B, Roy S, Sinha DP, Sarkar NC. Coronary artery lesions in Takayasu's arteritis--clinical and angiographic study. J Assoc Physicians India 1998;46:678-681.
15. Mellody KT, Freeman LJ, Baldock C, Jowitt TA, Siegler V, Raynal BDE, Cain ST, Wess TJ, Shuttleworth CA, Kielty CM. Marfan syndrome-causing mutations in fibrillin-1 result in gross morphological alterations and highlight the structural importance of the second hybrid domain. J Biol Chem 2006;281:31854-31862.
16. Helgadottir A, Thorleifsson G, Magnusson KP, Grétarsdottir S, Steinthorsdottir V, Manolescu A, Jones GT, Rinkel GJE, Blankensteijn JD, Ronkainen A, Jääskeläinen JE, Kyo Y, Lenk GM, SakalihasanN, Kostulas K, Gottsäter A, Flex A, Stefansson H, Hansen T, Andersen G, Weinsheimer S, Borch-Johnsen K, Jorgensen T, Shah SH, Quyyumi AA, Granger CB, Reilly MP, Austin H, Levey AI, VaccarinoV, Palsdottir E, Walters GB, Jonsdottir T, Snorradottir S, Magnusdottir D, Gudmundsson G, Ferrell RE, Sveinbjornsdottir S, HernesniemiJ, Niemelä M, Limet R, Andersen K, Sigurdsson G, Benediktsson R, Verhoeven ELG, Teijink JAW, Grobbee DE. The same sequence variant on 9p21 associates with myocardial infarction, abdominal aortic aneurysm and intracranial aneurysm. Nat Genet 2008;40:217-224.
17. Befeler B, Aranda MJ, Embi A, Mullin FL, El-Sherif N, Lazzara R. Coronary artery aneurysms: study of the etiology, clinical course and effect on left ventricular function and prognosis. Am J Med 1977;62:597-607.
18. Nozawa T, Imagawa T, Ito S. Coronary-Artery Aneurysm in Tocilizumab-Treated Children with Kawasaki's Disease. N Engl J Med 2017;377:1894-1896.
19. Khan IA, Dogan OM, Vasavada BC, Sacchi TJ. Nonatherosclerotic aneurysm of the left circumflex coronary artery presenting with accelerated angina pectoris: response to medical management--a case report. Angiology 2000;51:595-598.
20. Eshtehardi P, Cook S, Moarof I, Triller HJ, Windecker S. Giant coronary artery aneurysm: imaging findings before and after treatment with a polytetrafluoroethylene-covered stent. Circ Cardiovasc Interv 2008;1:85-86.
21. Unic D, Mihaljevic T, Leacche M, Gasparovic H, Albert MA, Byrne JG. Surgical treatment of a large left-main coronary artery aneurysm. Thorac Cardiovasc Surg 2004;52:230-231.
2. Ozeren M, Dogan OV, Dogan S, Yucel E. True and pseudo aneurysms of coronary arteries in a patient with Behçet's disease. Eur J Cardiothorac Surg 2004;25:465-467.
3. Nichols L, Lagana S, Parwani A. Coronary artery aneurysm: a review and hypothesis regarding etiology. Arch Pathol Lab Med 2008;132:823-828.
4. Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, Kazue T, Eto G, Yamakawa R. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation 1996;94:1379-1385.
5. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, De Bacquer D, Ducimetière P, Jousilahti P, Keil U, Njølstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel H, Whincup P, Wilhelmsen L, Graham IM, SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987-1003.
6. Morgagni GB. Founders of Modern Medicine: Giovanni Battista Morgagni (1682-1771). Med Library Hist J 1903;1:270-277.
7. Scott DH. Aneurysm of the coronary arteries. Am Heart J 1948;36:403-421.
8. Porcalla AR, Sable CA, Patel KM, Martin GR, Singh N. The epidemiology of Kawasaki disease in an urban hospital: does African American race protect against coronary artery aneurysms?. Pediatr Cardiol 2005;26:775-781.
9. Sharma SN, Kaul U, Sharma S, Wasir HS, Manchanda SC, Bahl VK, Talwar KK, Rajani M, Bhatia ML. Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study. Indian Heart J 1990;42:365-369.
10. Doustkami H, Maleki N, Tavosi Z. Left Main Coronary Artery Aneurysm. J Teh Univ Heart Ctr 2016;11:41-45.
11. Jha NK, Ouda HZ, Khan JA, Eising GP, Augustin N. Giant right coronary artery aneurysm- case report and literature review. J Cardiothorac Surg 2009;4:18.
12. Mata KM, Fernandes CR, Floriano EM, Martins AP, Rossi MA, Ramos SG. Coronary artery aneurysms: an update. In: Lakshmanadoss U, ed. Novel Strategies in Ischemic Heart Disease. Rijeka: InTech; 2012. p. 381–404.
13. Dajani AS, Taubert KA, Gerber MA, Shulman ST, Ferrieri P, Freed M, Takahashi M, Bierman FZ, Karchmer AW, Wilson W. Diagnosis and therapy of Kawasaki disease in children. Circulation 1993;87:1776-1780.
14. Panja M, Sarkar C, Kar AK, Kumar S, Mazumder B, Roy S, Sinha DP, Sarkar NC. Coronary artery lesions in Takayasu's arteritis--clinical and angiographic study. J Assoc Physicians India 1998;46:678-681.
15. Mellody KT, Freeman LJ, Baldock C, Jowitt TA, Siegler V, Raynal BDE, Cain ST, Wess TJ, Shuttleworth CA, Kielty CM. Marfan syndrome-causing mutations in fibrillin-1 result in gross morphological alterations and highlight the structural importance of the second hybrid domain. J Biol Chem 2006;281:31854-31862.
16. Helgadottir A, Thorleifsson G, Magnusson KP, Grétarsdottir S, Steinthorsdottir V, Manolescu A, Jones GT, Rinkel GJE, Blankensteijn JD, Ronkainen A, Jääskeläinen JE, Kyo Y, Lenk GM, SakalihasanN, Kostulas K, Gottsäter A, Flex A, Stefansson H, Hansen T, Andersen G, Weinsheimer S, Borch-Johnsen K, Jorgensen T, Shah SH, Quyyumi AA, Granger CB, Reilly MP, Austin H, Levey AI, VaccarinoV, Palsdottir E, Walters GB, Jonsdottir T, Snorradottir S, Magnusdottir D, Gudmundsson G, Ferrell RE, Sveinbjornsdottir S, HernesniemiJ, Niemelä M, Limet R, Andersen K, Sigurdsson G, Benediktsson R, Verhoeven ELG, Teijink JAW, Grobbee DE. The same sequence variant on 9p21 associates with myocardial infarction, abdominal aortic aneurysm and intracranial aneurysm. Nat Genet 2008;40:217-224.
17. Befeler B, Aranda MJ, Embi A, Mullin FL, El-Sherif N, Lazzara R. Coronary artery aneurysms: study of the etiology, clinical course and effect on left ventricular function and prognosis. Am J Med 1977;62:597-607.
18. Nozawa T, Imagawa T, Ito S. Coronary-Artery Aneurysm in Tocilizumab-Treated Children with Kawasaki's Disease. N Engl J Med 2017;377:1894-1896.
19. Khan IA, Dogan OM, Vasavada BC, Sacchi TJ. Nonatherosclerotic aneurysm of the left circumflex coronary artery presenting with accelerated angina pectoris: response to medical management--a case report. Angiology 2000;51:595-598.
20. Eshtehardi P, Cook S, Moarof I, Triller HJ, Windecker S. Giant coronary artery aneurysm: imaging findings before and after treatment with a polytetrafluoroethylene-covered stent. Circ Cardiovasc Interv 2008;1:85-86.
21. Unic D, Mihaljevic T, Leacche M, Gasparovic H, Albert MA, Byrne JG. Surgical treatment of a large left-main coronary artery aneurysm. Thorac Cardiovasc Surg 2004;52:230-231.
| Files | ||
| Issue | Vol 15 No 4 (2020): J Teh Univ Heart Ctr | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/jthc.v15i4.5944 | |
| Keywords | ||
| Coronary aneurysm Atherosclerosis Cardiac surgical procedures Prognosis | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Bjelobrk M, Dodic S, Miljkovic T, Samardzija G, Bjeljac I, Dabovic D, Dodic B, Rosic M, Kovacevic M, Redzek A, Fabri M. Asymptomatic Giant Aneurysm of the Left Anterior Descending Coronary Artery: A Case Report and Review of the Literature. J Tehran Heart Cent. 2020;15(4):178-182.
