Aneurysm of the left main coronary artery

Abstract

Aneurysm of the left main coronary artery is a rare angiographic finding, with few cases described in the interAneurysms in coronary arteries are rare entities, however, with potential severe complications. Usually they are multiple and atherosclerosis is responsible for more than 50% of the diagnosed adult cases in the Western world. The most affected places are, in order of frequency, the, proximal and mid portions of the right coronary, the proximal portion of the anterior descending branch, and the proximal portion of the circumflex branch 1,2 . Aneurysm of the left coronary trunk is extremely infrequent, with little more than 30 cases described in the literature.This report has the objective of presenting a case of aneurysm of the left main coronary artery and summarizing the available data from the literature about this uncommon entity and of its yet uncertain management. Case ReportThe patient was a 42-year-old male Caucasian fisherman with a 15-day history of acute myocardial infarction not treated with thrombolitics in his city of origin, as risk factors for coronary disease, smoking, and hyperlipemia where found. At cinecoronariography, occlusion of the right coronary, critical stenosis in the proximal portion of the anterior descending branch and circumflex branch, and an aneurysm of the left main coronary artery, measuring 23.6 x 15.8mm, with stasis of contrast in its interior and an important delay in distal coronary flow (Fig.1) were documented. The left ventricle maintained adequate contractibility, with a 62% ejection fraction. With no findings in the clinical history or laboratory examinations that night suggest vasculitis or endocarditis, and with the basal disease related to aneurysm, atherosclerosis seemed to us to be the most probable cause.The patient underwent myocardial revascularization, with the implant of the left internal mammary artery for the anterior descending and grafts of the saphenous vein for the first obtuse marginal branch and for the right coronary. The consensus as to the best strategy for treatment of aneurysm was to avoid the direct approach or closure of the aneurysm. The patient evolved well in postsurgery and was discharged from ITU on the second day. In the 180º post operative, the patient remains asymptomatic with noninvasive tests negative for myocardial ischemia.

Giant intraatrial septal aneurysm originating from a branch of the left coronary artery

“…3 In order of frequency, the proximal and mid portions of the right coronary, the proximal portions of the anterior descending branch, and the proximal portion of the circumflex branch are affected. 4 An intraatrial septal aneurysm, as our case, is uncommon. Saccular formation of CAA is known to be much rarer than fusiform CAA.…”

An unusual location and causation of coronary artery aneurysm and its surgical treatment—A case report

“…Coronary artery aneurysm is defined as a greater than 1.5-fold dilatation of a coronary segment, and is rarely seen on routine coronary angiography [4,11,12]. The most common causes of CAA are atherosclerosis and Kawasaki disease.…”

Aneurisma do tronco da artéria coronária esquerda

“…A doença de Kawasaki é a causa mais comum de aneurisma coronário no mundo, especialmente em crianças e mulheres. Nos Estados Unidos, a principal causa é a doença aterosclerótica 1 . Os aneurismas podem ser fusiformes ou saculares 6 , com predominância no sexo masculino, e a incidência varia na literatura entre 0,15% e 4,9% em pacientes submetidos a coronariografia 2,3 .…”

“…aneurisma de artéria coronária é uma afecção rara, com elevado potencial de complicações, e o aneurisma do tronco da artéria coronária esquerda é extremamente raro, com pouco mais de 30 casos descritos na literatura mundial 1 . Geralmente, os aneurismas das artérias coronárias são múltiplos e a aterosclerose coronariana é responsável por mais de 50% dos casos diagnosticados em adultos.…”