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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
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Giant proximal left anterior descending aneurysm causing multi-vessel myocardial ischaemia: the pressure is on-a case

Alexander Rutherford1, Badrinathan Chandrasekaran2, Mario Petrou3

  • 1Registrar, Great Western Hospital, Marlborough Road, Swindon SN3 6BB, UK.

European Heart Journal. Case Reports
|November 29, 2023
PubMed

Insights

Giant coronary artery aneurysms can cause myocardial ischemia. This case study shows surgical resection and bypass grafting effectively treated a large left anterior descending artery aneurysm causing ischemia.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Medical Imaging

Background:

  • Giant coronary artery aneurysms are rare, presenting diagnostic and therapeutic challenges.
  • These aneurysms can lead to myocardial ischemia through mass effect or altered blood flow dynamics.
  • Standardized management protocols for such rare conditions are lacking.

Observation:

  • A 55-year-old patient presented with angina, initially investigated with suboptimal computed tomography (CT).
  • Invasive angiography revealed a giant proximal left anterior descending (LAD) coronary aneurysm.
  • Further investigations included CT-fractional flow reserve (CT-FFR) and stress echocardiography (ECHO).

Findings:

  • CT-FFR and stress ECHO identified multi-vessel ischemia attributed to the LAD aneurysm.
  • The aneurysm exerted a pressure effect and potentially a 'steal effect' on LAD and left circumflex (LCx) arteries.
  • Surgical resection of the aneurysm and triple coronary artery bypass grafts were performed.

Implications:

  • This case underscores the value of advanced imaging techniques like CT-FFR and stress ECHO for evaluating complex coronary anomalies.
  • Functional imaging complements anatomical assessment, crucial for understanding the functional impact of coronary aneurysms.
  • Multidisciplinary team management and surgical intervention yielded positive outcomes for this rare presentation.
Abstract

Keywords:
CT-FFRCase reportCoronary artery aneurysmCoronary artery bypass graftStress echocardiography

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