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Dissecting aneurysms of the coronary arteries
Insights
Dissecting coronary aneurysms, rare heart conditions, were found in two autopsy cases. These findings suggest dissections may be more common than previously believed, often missed in clinical or macroscopic examinations.
Area of Science:
- Cardiovascular Pathology
- Aortic and Coronary Artery Diseases
Background:
- Coronary artery dissections are infrequently reported and often considered rare or fatal.
- Autopsy studies provide crucial insights into cardiovascular pathologies that may be missed during clinical evaluation.
Observation:
- Two cases of dissecting aneurysms involving coronary arteries were identified in 45 consecutive cardiac disease autopsies.
- One case presented with aortic and coronary artery dissection linked to cystic medial necrosis; the other showed a dissection limited to the right coronary artery.
Findings:
- Dissections were not clinically apparent and challenging to detect even with macroscopic examination of autopsy specimens.
- The presence of dissecting coronary aneurysms suggests they may be underdiagnosed, potentially contributing to unexplained sudden deaths or misattributed myocardial infarctions.
Implications:
- Coronary artery dissection may be a more prevalent condition than currently recognized.
- Further investigation, including detailed autopsy and potentially advanced imaging, is warranted to accurately diagnose and understand the clinical significance of dissecting coronary aneurysms.
Abstract:
This paper reports two cases of coronary dissecting aneurysms of the heart. These were found among 45 consecutive autopsy cases with cardiac diseases from January, 1978 to April, 1981. The first case, a 60-year-old woman, revealed dissecting aneurysm involving the aorta and three main coronary arteries in association with cystic medial necrosis. The second case, a 55-year-old man, revealed dissecting hematoma limited to the right coronary artery without any presumptive causal lesion to the dissection. The dissections could not be identified by either clinically or even macroscopic examinations of the autopsy materials. It is likely that the dissecting coronary aneurysm is not so uncommon nor fatal lesion as previously thought. Considerable number of the cases would be concealed in those of sudden death not autopsied or carelessly autopsied, or in those survived myocardial infarction not angiographied.