Left anterior descending coronary aneurysm
Julie-Ann S Lloyd1, Eric S Weiss, Luca A Vricella
1, Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Blalock 618, 600 N Wolfe St, Baltimore, MD 21287, USA.
Asian Cardiovascular & Thoracic Annals
|June 12, 2009
Insights
A ruptured coronary artery aneurysm caused cardiac tamponade in a young man. Surgical bypass using a saphenous vein graft successfully treated this rare cardiovascular emergency.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Imaging
Background:
- Coronary artery aneurysms are rare, particularly in young individuals.
- Ruptured coronary artery aneurysms can lead to life-threatening complications such as cardiac tamponade.
- Early diagnosis and prompt surgical intervention are crucial for favorable outcomes.
Observation:
- A 19-year-old male presented with retrosternal chest pain and hemodynamic instability.
- Echocardiography and CT revealed significant pericardial effusion causing cardiac tamponade.
- Intraoperative findings identified a 3-cm ruptured aneurysm of the left anterior descending coronary artery.
Findings:
- The ruptured left anterior descending coronary artery aneurysm was successfully repaired.
- A saphenous vein graft was used for bypass, anastomosed to the ascending aorta.
- The patient's hemodynamic instability resolved post-operatively.
Implications:
- This case highlights the importance of considering coronary artery aneurysms in the differential diagnosis of chest pain and hemodynamic compromise in young adults.
- Successful surgical management underscores the efficacy of bypass grafting for ruptured coronary artery aneurysms.
- Advances in cardiac imaging and surgical techniques improve the management of rare cardiovascular pathologies.
Abstract:
A 19-year-old man presented with gradual onset of retrosternal chest pain and hemodynamic instability. Echocardiography and computed tomography showed substantial anterior and posterior pericardial effusion with tamponade. At surgery, a 3-cm ruptured aneurysm of the left anterior descending coronary artery was identified. It was successfully bypassed using a saphenous vein graft anastomosed to the ascending aorta.
Related Concept Videos
01:30Aneurysm I: Introduction
An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
01:21Coronary Circulation
The heart, an organ critical to survival, gets nourishment not from the blood it pumps but from a separate circulation system known as coronary circulation. This is the shortest circulation in the body and is responsible for supplying the heart with the nutrients it needs to function effectively.
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
01:26Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
01:24Cardiac Catheterization III: Left Heart Catheterization
Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
01:15Aortic Regurgitation I: Introduction
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...