Successful Revascularization of Multiple Coronary Artery Aneurysms Using a Combination of Surgical Strategies

doi:10.1016/j.athoracsur.2007.04.023

The Annals of Thoracic Surgery

Volume 84, Issue 2, August 2007, Pages e10-e11

https://doi.org/10.1016/j.athoracsur.2007.04.023 Get rights and content

We report our approach to an unusual case of a 64-year-old man with multiple coronary artery aneurysms (CAAs) of the right, left anterior descending, and ramus coronary arteries. The right CAA was unusually large in size (measuring 5.5 cm). The aneurysms were obstructive, resulting in ischemic heart disease and heart failure. Multiple surgical techniques have been proposed to approach CAAs; however the ideal treatment strategy is poorly defined. This patient underwent successful revascularization using a combination of strategies, including aneurysm ligation, interposition reversed saphenous vein grafting, and bypass grafting. Surgical approach should be determined by aneurysm size, presence of branching vessels, and degree of stenosis.

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The CAA was first described postmortem by Morgagni [3] in 1761. Because CAA is a rare finding, no consensus surgical approach has been determined. Risks of CAA include spontaneous rupture, thrombosis, fistula formation, and myocardial ischemia [4]. Typically CAAs are repaired during coronary bypass grafting for ischemic heart disease, and multiple surgical techniques have been described including proximal and distal ligation of the aneurysm with coronary artery bypass grafting, aneurysm

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There are more references available in the full text version of this article.

Cited by (18)

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A 66-year-old male ex-smoker with hypertension, type 2 diabetes mellitus and dyslipidaemia was admitted due to a non-ST segment elevation myocardial infarction. The catheterisation depicted an extensive and calcified disease: chronic total obstruction of the right coronary and severe disease with a giant aneurysm at the first marginal branch as the culprit vessel. After discussion, the right coronary was treated before the circumflex-giant aneurysm was closed with a stent graft and its multiple severe stenosis solved with two drug-eluting stents. We provide a multimodality approach for a complex case and briefly discuss the available options.
Um homem de 66 anos, ex-fumador, hipertenso, com diabetes tipo II e dislipidemia, foi admitido por enfarte do miocárdio sem supradesnivelamento de ST. O cateterismo revelou doença extensa e calcificada: oclusão crónica e total da artéria coronária direita e doença severa com aneurisma gigante da primeira obtusa marginal, como lesão alvo. Após discussão, foi tratada a artéria coronária direita e posteriormente foi encerrado o aneurisma gigante de circunflexa com um stent e as suas múltiplas estenoses severas foram resolvidas com dois stents com fármaco. Providenciamos uma abordagem multimodal para um caso complexo e discutimos brevemente as diferentes opções possíveis.
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Citation Excerpt :
Surgical treatment is preferred for symptomatic patients who have evidence of embolization from the aneurysm to the distal coronary bed and those with large aneurysms, to avoid potential complications. Surgery is also indicated in cases of CAA enlargement in serial angiographic measurements.9 Various surgical techniques can be applied, such as isolating or resecting the aneurysm and reconstructing the coronary course using an interposition graft, or maintaining distal coronary flow via concomitant coronary artery bypass grafting.10
Coronary artery aneurysms are uncommon but potentially hazardous entities found on a small percentage of coronary angiograms. The best management strategy remains to be determined; the coexistence of obstructive coronary artery disease is the main determinant of prognosis.
We report the case of a middle-aged woman with mixed aneurysmal and obstructive coronary artery disease presenting as an acute myocardial infarction, probably due to atherosclerosis. The unusual severity and complexity of the angiographic presentation of this case, with involvement of all major coronary arteries, raises important issues in terms of the patient's treatment options.
Os aneurismas das artérias coronárias são entidades raras, presentes numa pequena percentagem das angiografias coronárias, embora associadas a complicações potencialmente graves. A melhor conduta no tratamento destas situações ainda não foi estabelecida e a coexistência de doença coronária obstrutiva é o principal determinante prognóstico.
Reportamos o caso de uma mulher de meia-idade com doença coronária mista, obstrutiva e aneurismática, diagnosticada no contexto de enfarte agudo do miocárdio e de provável etiologia aterosclerótica. A gravidade e a complexidade incomuns da apresentação angiográfica do nosso caso, levantaram aos autores questões importantes no domínio da decisão terapêutica.
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Dual aneurysms of the left anterior descending coronary artery initially detected by echocardiography: A case report with a literature review
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Case reportSuccessful Revascularization of Multiple Coronary Artery Aneurysms Using a Combination of Surgical Strategies

Section snippets

Comment

Ann Thorac Surg

Prog Cardiovasc Dis

J Thorac Cardiovasc Surg

Ann Thorac Surg

Case report
Successful Revascularization of Multiple Coronary Artery Aneurysms Using a Combination of Surgical Strategies