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[A surgical case report of angina pectoris with multiple coronary giant aneurysms]
T Imazeki1, T Yamada, M Yokoyama
1Department of Cardiovascular Surgery, Dokkyou University of Medicine, Koshigaya Hospital, Japan.
Insights
A 47-year-old man with severe angina underwent coronary artery bypass grafting for giant coronary aneurysms and stenoses. Post-surgery, grafts were patent, and aneurysms mimicked Kawasaki disease.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Imaging
Background:
- Severe angina pectoris necessitates surgical intervention.
- Coronary artery aneurysms present a complex surgical challenge.
- Preoperative assessment is crucial for planning complex cardiac procedures.
Observation:
- A 47-year-old male presented with severe angina.
- Coronary angiography revealed giant multiple aneurysms in the RCA, LCX, and LAD.
- Significant stenoses were noted distal to the aneurysms, alongside poor left ventricular function (EF 36%) due to anteroseptal infarction.
Findings:
- Coronary artery bypass grafting (CABG) was successfully performed using LITA to LAD and SVG to DX and LCX.
- Postoperative angiography confirmed all grafts were patent.
- The giant coronary aneurysms exhibited characteristics similar to coronary arterial changes seen in Kawasaki disease.
Implications:
- Successful surgical revascularization is feasible in patients with giant coronary aneurysms and significant stenosis.
- The findings suggest a potential link or differential diagnosis consideration between giant coronary aneurysms and Kawasaki disease.
- This case highlights the importance of advanced imaging and surgical techniques for managing complex coronary artery pathologies.
Abstract:
A 47-year-old man with sever angina pectoris was referred for surgery. Preoperative coronary angiogram revealed giant multiple aneurysms of RCA (Seg 1-Seg 3) and LCX (Seg 11) and LAD (Seg 6). Stenoses were found distal to aneurysm, 90% in RCA-Seg 4, CX-Seg 11, 100% in LAD- Seg 6 and DX-Seg 9 and OM-Seg 12, with collaterals from RCA to LAD. Left ventlicle contracted poorly with the EF of 36 due to anteroseptal infarction. Coronary artery bypass grafting were performed to LAD using a LITA, to DX and LCX using a SVG in the sequential fashion. Postoperative coronary cineangiogram demonstrated that all grafts were patent and multiple giant coronary aneurysms resembled coronary arterial changes of Kawasaki's disease.