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A Rare Case of Coronary Artery Dilatation and Giant Pseudoaneurysm.

ABSTRACT: Coronary artery fistula are anomalous connections with coronary vessels or cardiac chambers, potentially resulting in coronary dilatation and pseudoaneurysm formation. We present the case of a 68-year-old woman referred to our institution for a voluminous coronary pseudoaneurysm secondary to coronary artery fistula presenting as a nearly completely obstructive left atrial mass. (Level of Difficulty: Intermediate.).

SUBMITTER: De Marco C

PROVIDER: S-EPMC8311181 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

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A Rare Case of Coronary Artery Dilatation and Giant Pseudoaneurysm.

De Marco Corrado C Boulet Jacinthe J Aldhaheri Eisa E Grondin Stéphanie S Pham Magali M L'Allier Philippe L PL Bouchard Denis D Basmadjian Arsène J AJ

JACC. Case reports 20210505 5

Coronary artery fistula are anomalous connections with coronary vessels or cardiac chambers, potentially resulting in coronary dilatation and pseudoaneurysm formation. We present the case of a 68-year-old woman referred to our institution for a voluminous coronary pseudoaneurysm secondary to coronary artery fistula presenting as a nearly completely obstructive left atrial mass. (<b>Level of Difficulty: Intermediate.</b>). ...[more]

PMID: 34317626

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Unusual Case of Giant Nonthrombosed Right Coronary Artery Pseudoaneurysm With Coronary Artery Fistula.

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Giant aortic root pseudoaneurysm surrounding the left main coronary artery.

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A rare case of idiopathic giant left ventricular pseudoaneurysm.

Project description: Not available

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Right coronary artery fistula with giant pseudoaneurysm presenting as intrapericardial mass.

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

Rare case of a giant thrombosed left anterior descending coronary artery aneurysm.

Project description:BackgroundCoronary artery aneurysms (CAAs) are rare, and giant CAAs are even rarer. The pathophysiology of this phenomenon is still unknown.Case presentationHerein, we present the case of a 49-year-old male with a giant aneurysm in the left anterior descending artery.ConclusionsThe optimal treatment for CAAs is debatable, but surgical intervention is preferred for giant CAAs.

| S-EPMC7393696 | biostudies-literature

Recurrence following percutaneous exclusion of giant coronary pseudoaneurysm: a case report.

Project description:BackgroundEmergence of coronary giant pseudoaneurysm (PSA) after stent implantation is potentially catastrophic and may end up with life threatening complications if not managed promptly. There is scarcity of data in existing literature with respect to guidelines on the management of coronary PSA following stent implantation. We report the recurrence of coronary PSA following initial percutaneous management of a giant coronary PSA using multiple stent grafts.Case presentationA 38-year-old male who underwent primary angioplasty of the right coronary artery (RCA) about a month back, presented with dull aching precordial chest pain for the last 15 days. A repeat coronary angiography revealed giant coronary PSA in proximal to mid RCA. Considering the significantly large size of the coronary PSA with symptoms of impending rupture, the giant coronary PSA was successfully excluded by implanting three sequentially coronary stent grafts. However, after one and a half months, the patient again presented with a similar kind of dull aching chest pain. We found a recurrence of coronary PSA in a segment of the coronary artery distal to the portion excluded by stent grafts. This recurrent coronary PSA was once again successfully excluded by redeploying two more stent grafts with the help of a guide extension catheter.ConclusionsIn this case, vessel wall injury as a result of aggressive post dilatation using an oversized balloon during the index procedure was the contributor to the giant coronary PSA formation. It usually appears early after the index procedure (within 4 weeks). Though the usual strategy used to exclude coronary aneurysm is by using the minimal number of stent grafts (due to the inherent increased risk of restenosis/thrombosis in stent grafts) in post angioplasty traumatic aneurysm it is prudent to exclude the entire damaged artery by placing stent grafts to prevent recurrence in segments with even minimal dilatation on initial evaluation.

| S-EPMC11371973 | biostudies-literature

Congenital coronary artery-to-pulmonary fistula with giant aneurysmal dilatation and thrombus formation: a case report and review of 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

Spontaneous coronary artery dissection and aortic dilatation presenting concomitantly: a case report.

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

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

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

A case report of pseudoaneurysm of coronary artery within a month of percutaneous coronary intervention.

Project description:BackgroundCoronary artery pseudoaneurysms (PSAs) are uncommon and have poorly understood natural history. Unlike true aneurysms, PSAs do not have all the three layers of the vessel in the aneurysmal wall. The PSAs are most commonly seen after an overzealous percutaneous coronary intervention (PCI) which causes damage to the vessel wall. They usually develop slowly after PCI and PSAs within a month of a PCI are not so common. The PSA may be asymptomatic or present with recurrent angina.Case summaryHere, we report a case of symptomatic PSA to right coronary artery (RCA). The patient had a myocardial infarction for which a PCI was performed to deploy a drug-eluting stent (DES) in the RCA. The patient had in-stent restenosis (ISR) within a week of PCI for which plain old balloon angioplasty (POBA) was performed. The patient continued to have unstable angina and within a month of POBA was diagnosed as a case of PSA by intravascular ultrasound. A covered stent was deployed which effectively sealed off the PSA and resumed normal blood flow to distal vessel. Patient has been doing well on medication [aspirin 75 mg once daily, atorvastatin 80 mg once daily, and P2Y12 platelet inhibitor (Ticagrelor) 90 mg twice daily].DiscussionThe PSAs usually take 6-9 months to develop. However, PSAs have been reported within 1-2 months of PCI. This case also shows that PSAs can occur within a month of PCI. It is possible that over-aggressive and/or high-pressure dilatation and/or deep engagement during POBA performed to open up the ISR could have damaged the struts of the DES and compressed it against the vascular wall. The resultant vascular wall injury could have been the cause of early PSA formation in this case. Hence, cardiologists should be vigilant enough to suspect PSA, especially in a patient presenting with angina. The case also shows that covered stents are a viable option to treat early presentations of PSA.

| S-EPMC9071343 | biostudies-literature

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