Acute Myocardial Infarction That Resulted From Poor Adherence to Medical Treatment for Giant Coronary Aneurysm

Motozawa, Yoshihiro; Uozumi, Hiroki; Maemura, Sonoko; Nakata, Rieko; Yamamoto, Keisuke; Takizawa, Masataka; Kumagai, Hidetoshi; Ikeda, Yuichi; Komuro, Issei; Ikenouchi, Hiroshi

doi:10.1536/ihj.15-155

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…9,10) Coronary KD sequelae is one of the underlying diseases of coronary events in young adults. 11,12) The present case also showed moderate intimal thickening with surrounding calcification at the aneurysm in the proximal LAD accompanied with lumen narrowing at the inlet on OFDI, and the aneurysm could not be delineated by CAG alone. In contrast, coronary computed tomography (CT) before the first PCI depicted eggshelllike calcified aneurysm in the proximal LAD and enlargement in the left main trunk and in the just proximal LAD, in which vessel diameters at the aneurysm and the distal reference were 6.1 mm and 3.5 mm, respectively, while no definite plaques were observed in the mid-distal LAD, right coronary artery, or left circumflex coronary artery.…”

Section: Discussionmentioning

confidence: 53%

Rotational Atherectomy Followed by Drug-Coated Balloon Dilation in Possible Coronary Sequelae of Kawasaki Disease

et al. 2016

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SummaryRotational atherectomy with/without low-pressure balloon dilation has been a mainstay of interventional treatment for stenosis due to the coronary sequelae of Kawasaki disease (KD). Here, we report a restenosis case of probable coronary sequelae of KD treated with rotational atherectomy with low-pressure 2.5-mm balloon dilation 6 months previously. Under the guidance of optical frequency domain imaging, we performed rotational atherectomy followed by 2.5-mm drug-coated balloon (DCB) dilation for an atherosclerotic restenosis at the inlet of a calcified aneurysm in the proximal left anterior descending coronary artery. Coronary angiography 6 months later showed no apparent progression of vessel narrowing, and we could defer repeat intervention. The present case suggests that rotational atherectomy followed by DCB dilation could be an alternative revascularization therapy of choice in coronary KD sequelae complicated with atherosclerosis. (Int Heart J 2016; 57: 367-371) Key words: Optical frequency domain imaging, Fractional flow reserve, Atherosclerosis, Dyslipidemia C oronary sequelae of Kawasaki disease (KD) has a variety of morphological manifestations, such as aneurysm, stenosis, and total occlusion concomitant with nonatherosclerotic intimal thickening and frequent severe calcification, while a few reports have demonstrated early atherosclerosis progression in young adults with prior KD.1-3) Since these stiff calcified lesions have risk of stent underexpansion and neo-aneurysmal formation ascribed to high-pressure balloon inflation, rotational atherectomy with/without additional low-pressure balloon dilation alone has been a mainstay of interventional treatment for stenosis due to the coronary sequelae of KD. [4][5][6] In contrast, drug-coated balloons (DCB) now play a central role in the treatment of in-stent restenosis through their inhibition of neointimal hyperplasia, despite the lack of evidence for de novo coronary artery disease. 7,8) We describe here our experience with an atherosclerotic-restenosis case of probable coronary sequelae of KD previously treated with rotational atherectomy with additional low-pressure balloon dilation 6 months before, 3) in which rotational atherectomy followed by DCB dilation could defer any subsequent repeat intervention. Case ReportAn asymptomatic 47 year-old male was admitted to our hospital to undergo 6-month follow-up coronary angiography (CAG). Six months previously, based on a diagnosis of silent myocardial ischemia due to possible sequelae of KD, we had performed rotational atherectomy with 1.5/2.0 mm burrs followed by low-pressure dilation using a balloon catheter 2.5/15 mm at 4 atm for a stenosis at the inlet of a calcified aneurysm in the proximal segment of the left anterior descending coronary artery (LAD) ( Figure 1A, 1B). Although he had no apparent history of KD, he was hospitalized for 40 days due to fever of unknown cause with systemic eruption at the age of 6 months. His coronary risk factor was dyslipidemia, and under medication consisting ...

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Section: Discussionmentioning

confidence: 53%

Rotational Atherectomy Followed by Drug-Coated Balloon Dilation in Possible Coronary Sequelae of Kawasaki Disease

et al. 2016

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“…The prognosis of aneurysm was rather dangerous and many patients died from the bleeding secondary to the rupture of aneurysm. 3,4) Only those aneurysms could be stable and calcified gradually in the minority of patients. Although the inflammatory tissues surrounding the aneurysm might be difficult to be repaired, the aneurysm in this report grew very rapidly.…”

Section: Discussionmentioning

confidence: 99%

An Infectious Pseudoaneurysm Caused by Ventricular Septal Defect Occluder in Patent Ductus Arteriosus Closure in a Two-Year-Old Child

Qiu

Jin

et al. 2017

Int. Heart J.

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SummaryWe present a case of an infectious pseudoaneurysm after patent ductus arteriosus (PDA) closure with a ventricular septal defect (VSD) occluder in a two-year-old child. The aneurysm grew rapidly but was successfully removed in time and the patient survived. To our knowledge, this is the first report of an infectious pseudoaneurysm caused by VSD occluder in PDA closure.(Int Heart J 2017; 58: 1017-1019) Key words: Aneurysmal dilatation, Infectious endocarditis, Transcatheter A neurysmal dilatation of ductus arteriosus has been considered a rare but potentially fatal abnormality. It can be either congenital or acquired as a complication of surgical ligation of patent ductus arteriosus (PDA) or after a ductal infection. And the congenital ones were much commoner than the acquired ones. In the early days, the surgical method for PDA was excision, which was replaced by occluder nowadays. There were case reports on ductus arteriosus aneurysm in PDA excision.1,2) However, to our knowledge, this is the first report of pseudoaneurysm caused by PDA occluder. Case ReportA two-year-old girl (weighing 10.5 kg) presented with a week history of cough. A physical examination revealed a continuous murmur at the second left intercostal space. Transthoracic echocardiogram revealed a PDA (Figure 1).The patient underwent right heart catheterization. A 5 French (Fr) sheath was inserted into the right femoral vein, followed by a 5-Fr MPA1 catheter, and right-sided pressures were recorded. The catheter was removed, flushed, and then inserted into the right femoral artery. The left-sided pressures were then recorded.The patient was found to have a funnel-shaped PDA (5 mm pulmonary end diameter, 13 mm aortic end diameter and 8 mm length) with preprocedural shunt and Qp:Qs of 4.1:1 (Figure 2). Right heart catheterization demonstrated a pulmonary arterial pressure of 90 mmHg/50 mmHg (mean 63 mmHg) with a mean pulmonary capillary wedge pressure of 7 mmHg. The pulmonary vessel resistance was 459 dynes sec cm-5.A 14 mm muscular ventricular septal defect (mVSD) occluder (Starway Medical Technology, China) was advanced to the site of the PDA through a 9 Fr delivery system. Its subsequent deployment closed the PDA. Postprocedural pulmonary arterial pressure was recorded as 50 mmHg/30 mmHg (mean 37 mmHg). Postoperative transthoracic echocardiogram (TTE) found no residual shunt. 0.5 g Cefazolin was given prophylactically 40 minutes before the procedure and 11.5 hours after the procedure. The postoperative examinations were normal and the patient was discharged. However, the patient came down with a fever of 40 15 days after the procedure and was transferred from a local hospital to ours. The high fever has been lasting and no response for medicines with Vancomycin and Meropenem for 2 weeks at local hospital. TTE showed that the occluder seemed to drop into the main pulmonary artery. The cardiac computed tomographic angiography revealed an aneurysmal dilatation of the ductus arteriosus with a maximum diameter of 30 mm (Figure 3, 28*30 mm). The...

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“…6,15) Atherosclerotic disease is the major cause of CAA, apart from autoimmune responses, such as Kawasaki disease and Behcet's disease, and connective tissue disorders, such as Ehlers-Danlos disease and Marfan syndrome. [16][17][18] PCIrelated CAAs are rare and caused by chemical and mechanical factors. [19][20][21] Chemical factors include allergic reaction to metals, polymer-induced hypersensitivity, and infection, and the incidence of CAAs is higher after DES implantation than after BMS implantation.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Aneurysm Caused by a Stent Fracture

et al. 2018

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SummaryCoronary stent fracture (SF) is rare as a complication of percutaneous coronary intervention (PCI), and its adverse events are increasingly being recognized with the development in devices of PCI. The major adverse events caused by SFs are in-stent restenosis due to neointimal overgrowth caused by poor drug delivery.1,2) A coronary artery aneurysm (CAA) is a rare complication of SF, but may lead to lethal events such as acute coronary syndrome or rupture of the CAA further leading to cardiac tamponade. [3][4][5] However, the management of CAAs is controversial with or without SF.6) Herein, we report a case of a CAA caused by an SF and discuss the management of CAA complicated with SF, along with a literature review. We suggest that surgical treatment should be considered the higher-priority strategy in the cases of CAA with SF as compared to CAA without SF.(Int Heart J 2018; 59: 203-208) Key words: Coronary artery disease, Drug-eluting stent, In-stent restenosis A lthough the use of drug-eluting stents (DESs) has significantly improved its long-term outcomes after percutaneous coronary intervention (PCI), instent restenosis (ISR) still occurs in some cases and target vascular revascularization is required. 7,8) Coronary stent fracture (SF) is increasingly being recognized as one of the causes of ISR.1) SF can be classified into several types, and complete and severe fracture types rarely lead to coronary artery aneurysm (CAA).9,10) Thus far, the established treatment and management for CAAs with SF are unclear. Case ReportA 69-year-old man with multiple coronary risk factors, including hypertension, hyperlipidemia, type-2 diabetes mellitus, smoking history, and chronic kidney disease, presented to our hospital for a follow-up coronary angiography (CAG) 6 months after PCI. He had undergone CAG and PCI several times as described below.In 2003, an electrocardiogram showed ST segment depression, and a cardiac exercise stress test and radioisotope revealed ischemic changes in the anterior and inferior segments of the left ventricle; therefore, CAG was performed for the first time. CAG demonstrated 90% stenosis in the proximal right coronary artery (RCA) and 75% stenosis in the proximal left anterior descending artery (LAD) with mild stenosis in the left circumflex artery (LCX). PCI was successfully performed, and bare-metal stents (BMSs; 4.0 × 13 mm and 3.5 × 20 mm) were implanted in the ostium of the RCA and proximal LAD, respectively. Six months later, in 2004, a follow-up CAG revealed no in-stent restenosis (ISR), and dual antiplatelet therapy (DAPT) was changed to single antiplatelet therapy (SAPT). In 2014, the patient was diagnosed with earlystage gastric cancer, and CAG was performed before the gastric cancer surgery. CAG revealed ISR in the RCA and progression of the stenosis in the LCX. A week before the surgery, SAPT was changed to heparin, and DAPT was started after it. Following the surgery, PCI was performed and a zotarolimus-eluting stent (Resolute Integlity 2.5 × 22 mm) was implanted in the LCX,...

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Acute Myocardial Infarction That Resulted From Poor Adherence to Medical Treatment for Giant Coronary Aneurysm

Cited by 9 publications

References 14 publications

Rotational Atherectomy Followed by Drug-Coated Balloon Dilation in Possible Coronary Sequelae of Kawasaki Disease

Rotational Atherectomy Followed by Drug-Coated Balloon Dilation in Possible Coronary Sequelae of Kawasaki Disease

An Infectious Pseudoaneurysm Caused by Ventricular Septal Defect Occluder in Patent Ductus Arteriosus Closure in a Two-Year-Old Child

Coronary Artery Aneurysm Caused by a Stent Fracture

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