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[Giant coronary artery aneurysm in diagonal artery; report of a case]
J Koizumi1, H Izumoto, A Ohsawa
1Department of Cardiovascular Surgery, Iwate Medical University, Memorial Heart Center, Morioka, Japan.
Insights
A rare 6 cm giant coronary artery aneurysm in the diagonal artery was successfully treated with bypass surgery and obliteration. This case highlights potential links between coronary arteritis and Kawasaki disease in adults.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Pathology
Background:
- Giant coronary artery aneurysms (GCAAs) are rare, particularly in adults.
- Coronary artery aneurysms can be associated with vasculitis, such as Kawasaki disease.
Observation:
- A 44-year-old woman presented with a 6 cm intracardiac mass, later identified as a giant aneurysm of the diagonal artery.
- The aneurysm contained a large thrombus and showed signs of atherosclerotic change, vascular layer destruction, and inflammatory cell infiltration.
Findings:
- Surgical intervention involved median sternotomy, cardiopulmonary bypass, thrombus removal, and left internal thoracic artery bypass grafting.
- The aneurysm was successfully obliterated, and the patient recovered without complications.
Implications:
- This case underscores the importance of considering coronary arteritis and its potential link to Kawasaki disease in adult GCAA presentations.
- Successful surgical management of GCAAs is achievable, even in complex cases with significant thrombus.
Abstract:
We report a giant coronary artery aneurysm occurred in the diagonal artery. A 44-year-old woman was referred to our institution for further examination of chest X-ray abnormality. Computed tomography revealed a 6 cm intracardiac mass adjacent to pulmonary artery. Cardiac catheterization revealed a giant coronary artery aneurysm with the large thrombus in the diagonal artery. A giant aneurysm 6 cm in diameter was exposed through a median sternotomy. Under beating heart with cardiopulmonary bypass, the aneurysm was opened and organized thrombus was removed. The influx and efflux of the aneurysm were identified and ligated. Under arrested heart with cardioplegia, the diagonal artery was bypassed with the left internal thoracic artery. Finally the aneurysm was obliterated with the running suture. The patient discharged at the 17th postoperative day without any complications. Histologic evaluation of the resected aneurysm revealed atherosclerotic change, destruction of vascular layers and infiltration of inflammatory cells. These findings suggested previous history of coronary arteritis. The coronary aneurysm in this case might be resulted from Kawasaki disease.