[Large coronary artery aneurysms. A study of 20 clinical cases in the elderly]

The aim of this study was describe the anatomical features of coronary aneurysms and assess their role in causing death. Twenty clinico-pathological cases were recensed prospectively out of 8,920 autopsies (0.22%). The average age at death was 68 +/- 20 years (14 men and 6 women). Death was due to a cardiac cause in 90% of cases. The aneurysms were located on a single coronary artery in 14 cases, on 2 coronary arteries in 3 cases, and on all three arteries in 3 cases with a mean maximum diameter of 15 +/- 4.5 mm. Aneurysms of the right coronary artery were the most common (p < 0.01) and the largest (16.7 +/- 3.8 mm; p = 0.12) and circumflex arteries (12 +/- 3.1 mm, p = 0.03). The diameter of the coronary aneurysm was greater in the more elderly patients (r = 0.51 ; p = 0.022). The coronary aneurysms were diffuse in 10 subjects and localised in the other 10 (mainly fusiform and proximal). Only 3 aneurysms were directly associated with significant stenosis of the same artery. The aetiology was atherosclerosis in 18 cases, with associated extra-cardiac disease in 14 cases; the other 2 cases were dystrophic. The underlying anatomical abnormality constantly found was variable degrees of atrophy and destruction of the musculo-elastic elements of the media, a source of dilation. In 80% of cases, thrombosis of the aneurysm was directly or indirectly responsible for death. Coronary artery aneurysms are a rare finding and are frequently complicated by fatal thrombosis. Coronary angiographic detection of this condition characterised by the large size and absence of stenosis of the artery should lead to prophylactic antithrombotic therapy.