A Rare Case of Coronary Artery Dilatation and Giant Pseudoaneurysm.
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ABSTRACT:
SUBMITTER: De Marco C
PROVIDER: S-EPMC8311181 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Coronary artery aneurysm and pseudoaneurysm are rare and mainly result from atherosclerosis. We present a successfully treated case of a giant right coronary artery aneurysm and pseudoaneurysm with a coronary artery fistula, which might have developed after cardiac surgery for a right ventricular tumor 35 years earlier. (Level of Difficulty: Advanced.).
| S-EPMC8311150 | biostudies-literature
Project description: Not available
| S-EPMC8114726 | biostudies-literature
Project description:A 69-year-old patient underwent an urgent aortic valve replacement because of Streptococcus agalactiae endocarditis of his native aortic valve. Since a rapid progression of the former abscess cavity into an aortic root pseudoaneurysm with increasing paravalvular regurgitation during postoperative follow-up, reoperation was performed. In the preoperative transesophageal echocardiography (TEE) images the pseudoaneurysm completely surrounds the left coronary artery (LCA) without any signs of myocardial ischemia.
| S-EPMC8617378 | biostudies-literature
Project description:Coronary artery fistulas are rare congenital anomalies usually discovered incidentally on imaging studies. Coronary artery pseudoaneurysms are unusual complications of coronary artery fistulas, which can be due to atherosclerosis, inflammatory, traumatic or iatrogenic causes. We present a case of a 55 year old female with no known atherosclerotic risk factors, history of trauma or connective tissue disease referred because of recurrent palpitations. Work ups revealed a cardiac mass with an initial assessment of pericardial cyst. A multi modality approach of two dimensional echocardiography with Doppler studies, multidetector computed tomography and coronary angiogram revealed coronary artery fistula draining into a pericardial mass. The patient underwent surgical excision of the mass and ligation of the feeding vessel. Histopathology revealed features suggestive of a pseudoaneurysm. Postoperative course was uneventful and she was discharged stable and improved. Coronary artery fistula complicated by pseudoaneurysm is a rare clinical entity especially in patients without history of trauma or other risk factors. It can have an unusual presentation which can confound the diagnosis. Multimodality imaging is essential and adjunctive in order to determine a conclusive assessment. <Learning objective: Coronary artery pseudoaneurysm secondary to a congenital coronary artery fistula is an unusual cardiovascular pathology and can present as a rare diagnostic challenge for the clinician. This case emphasizes the importance of meticulous integration of both clinical assessment and complementary multimodality imaging approaches to better define the best therapeutic plan and facilitation of definitive surgical management.>.
| S-EPMC6149593 | biostudies-literature
Project description:BackgroundCoronary artery-to-pulmonary artery fistula is a rare disorder characterized by abnormal vascular communication between the coronary artery and pulmonary artery. While most patients remain asymptomatic, some might exhibit symptoms of myocardial ischemia, congestive heart failure, or even sudden cardiac death if coronary aneurysm, thrombosis, infective carditis, or other congenital cardiac defects coexist. Case presentation We present a 66-year-old male complaining of angina pectoris with a history of hypertension and active smoking. He was diagnosed with a coronary aneurysm based on coronary computed tomography angiography. We subsequently identified a coronary artery-to-pulmonary artery fistula with giant aneurysmal dilation on coronary angiography. Ultimately we conducted surgery ligation and aneurysmorrhaphy. During surgery, we discovered newly formed thrombus within the aneurysmal cavity. Histological analysis of the aneurysmal wall supported the diagnosis of the congenital disorder. Our patient was successfully discharged and remained asymptomatic at two months of follow-up.ConclusionWe presented a rare and complex combination of congenital coronary artery-to pulmonary artery fistula, giant coronary aneurysmal dilatation, and thrombosis through multi-modality evaluations.
| S-EPMC8176730 | biostudies-literature
Project description:IntroductionSpontaneous coronary artery dissection (SCAD) is defined as a non-traumatic, non-iatrogenic, non-atherosclerotic separation of the coronary arterial walls, creating a false lumen. The space created is filled with an intramural haematoma (IMH) that compresses the true arterial lumen, decreasing anterograde blood flow. Spontaneous coronary artery dissection is commonly associated with small and medium sized extracoronary vascular abnormalities.Case presentationThis case report describes a case of SCAD presenting as an acute coronary syndrome together with aortic dilatation requiring aortic valve and aortic root replacement.DiscussionDespite the fact that SCAD and aortic dilatation share common aetiologies, this is the first case to our knowledge describing severe aortic dilatation and SCAD presenting concomitantly. This case highlights the importance of confirming the diagnosis of SCAD with intravascular imaging and of investigating for extracoronary arteriopathies.
| S-EPMC6426025 | biostudies-literature
Project description:BACKGROUND:The combination of multiple giant coronary artery aneurysms (CAAs) and right coronary artery (RCA) to pulmonary artery (PA) fistula is extremely rare and the patients with CAAs may suffer from several fatal complications. We herein describe a 60-year-old female with hemodynamic instability who was diagnosed with multiple giant CAAs combined with RCA-PA fistula. CASE PRESENTATION:The patient, a 60-year-old female, presented to the emergency room because of progressive exertional chest distress and fatigue. The transthoracic echocardiography (TTE), coronary computed tomography angiography (CTA) and invasive coronary angiography confirmed the existence of multiple giant CAAs and RCA-PA fistula. Laboratory examinations for systemic vasculitis and infectious diseases demonstrated no abnormalities and work-up for childhood and family history were negative. We have performed a successful surgical treatment for this patient. The patient's restrictive cardiac dysfunction was improved after debriding the advanced thrombi in aneurysm sac and ligating the fistulous vessel between the native RCA and PA. The postoperative pathologic examination of the aneurysmal wall revealed loss of smooth muscle cells in the media with local mucoid degeneration, no chronic inflammation, sclerosis and IgG4 were observed. CONCLUSIONS:The treatment decision-making process should depend upon the patients' specific situations. Our case suggests the surgical intervention should be accepted as the preferred treatment for giant CAAs with restrictive cardiac dysfunction.
| S-EPMC6612139 | biostudies-literature
Project description:BackgroundAneurysms of the extracranial carotid artery are a rare entity and correspond to <1% of all arterial aneurysms.Case summaryA 58-year-old male with known human immunodeficiency virus (HIV) infection presented in the emergency department with a massive cervical tumour on the right side of the neck and a severe occipital pain. Contrast computed tomography demonstrated a pseudoaneurysm of the proximal right internal carotid artery (ICA). Open surgery of the ICA was performed with reconstruction of the posterior vessel wall, embolectomy of the ICA, and anterior pericardial patch reconstruction. After an uneventful postoperative course, the patient was readmitted 4 weeks later with a right retrobulbous haematoma caused by a carotid cavernous fistula. Therefore a coil-embolization of the fistula and finally of the distal right carotid artery was performed.DiscussionIn patients with a proven HIV infection, the occurrence of a vasculopathy in the extra- or intracranial carotid artery is significantly increased and the second most common site after the lower extremities. In patients with progredient neck swelling it should be considered in the differential. Surgical therapy is the preferred treatment strategy in the extracranial aneurysm type, especially in this patient collective.
| S-EPMC9269677 | biostudies-literature
Project description:BackgroundCoronary artery fistula complicated with giant coronary artery ectasia (CAE) is a rare cardiac malformation, and its surgical indications and treatment strategies still need further discussion.Case summaryIn this case, a 41-year-old man had complained of occasional dizziness for 2 years, but he did not seek medical attention until he started to feel palpitations. A right coronary artery (RCA)-left ventricular (LV) fistula with giant RCA of diffuse ectasia was firstly revealed by transthoracic echocardiography. A widened left ventricle and significantly constricted right atrium and right ventricle were also detected by three-dimensional coronary artery computed tomography. Surgical treatment, including the repair of the RCA-LV fistula, the resection and reconstruction of the dilated RCA and coronary artery bypass grafting (CABG) under hypothermic cardiopulmonary bypass, were performed to correct the malformation. The patient presented a favourable health condition without any discomfort at the 1-year follow-up.DiscussionCAE can be caused by various congenital or acquired factors. Surgical treatment, such as transcatheter embolization excision, surgical ligation or resection for symptomatic patients with CAE three times or larger than the reference diameter, has been reported to have satisfactory results. Additionally, CABG can be selected if myocardial perfusion is compromised and the distal branch is of reasonable size. In this case, the giant ectasia of the RCA may have been a consequence of the congenital RCA-LV fistula. Atherosclerosis, with calcified plaques in the RCA, and the patient's long-term history of smoking may have contributed to the development of giant ectasia of the RCA.
| S-EPMC7811206 | biostudies-literature
Project description:BackgroundSingle coronary artery (SCA) is a rare congenital coronary anomaly with incidence of 8-66 per 100 000 cases. Percutaneous coronary intervention (PCI) in patients with SCA is technically challenging. This is a case of bifurcation angioplasty involving left anterior descending/right coronary artery (LAD/RCA) in a patient with SCA and 1-year follow-up with computed tomography coronary angiography (CTCA).Case summaryA 52-year-old female with history of PCI to LAD 4 months back, presented with non-ST-elevation myocardial infarction. Coronary angiogram showed 90% stenosis in mid-LAD, distal to the previous stent and proximal to an anomalously originating RCA from mid-LAD. She was planned for LAD/RCA provisional bifurcation angioplasty and a drug-eluting stent was deployed in LAD across RCA, following which patient developed angina with ischaemic electrocardiogram (ECG) changes due to significant pinching of RCA. Using Reverse crush technique, RCA was stented successfully with resolution of angina and ECG changes. At 1-year follow-up, patient is in New York Heart Association class I with normal left ventricular function and patent LAD/RCA bifurcation stent on CTCA.DiscussionSCA poses a great challenge to interventional cardiologists during PCI, especially in the event of a complication. Detailed anatomical knowledge, appropriate hardware and operator expertise are the key factors for successful PCI of SCA. This is, to the best of our knowledge, the first case report of bifurcation angioplasty of LAD/RCA in a rare case of SCA. This case also describes the use of reverse crush technique as a bailout strategy during provisional bifurcation angioplasty.
| S-EPMC8188865 | biostudies-literature