Echocardiographic features of a giant congenital aneurysm of the right coronary artery

Abstract

Coronary artery aneurysms are uncommon, but since the introduction of coronary angiography and more recently echocardiography, several cases have been reported in the In this report we describe the echocardiographic features of an unruptured giant aneurysm of the right coronary artery, which was proved and successfully excised at operation. REPORT ON PATIENTA 25-year-old woman had been well until three months before admission when she experienced palpitation, cough, shortness of breath, and at times dizziness. Peripheral edema was intermittently present. An echocardiographic study suggested a right ventricular mass. On physical examination, the patient appeared ill with purplish-red cheeks, slight icterus sclera, and mild engorgement of the jugular veins. Her blood pressure was 110/90 mmHg and her heart rate was regular at 105 beatdmin. On auscultation, S1 and S2 were normal, and a S4 was heard over the precardium. A grade II/VI systolic ejection murmur was present along the left sternal border. Mild cyanosis at the tip of the fingers without clubbing was noted. The liver was enlarged and there was mild edema of the lower extremities. The chest X-ray showed a slighly enlarged heart shadow with a cardiothoracic ratio of 0.55 and a slightly decreased pulmonary vascularity. The electrocardiogram showed sinus tachycardia, low QRS voltage, and a Q wave in V3-V6 in- 502dicating an old anteroseptal myocardial infarction. Parasternal long-axis two-dimensional echocardiography showed a large oval cystic mass measuring 8 x 12 cm. Cloud-like echoes moved turbulently in the cystic cavity while the cystic mass itself showed little motion. The left atrium and ventricle were very small. The motion of the mitral and aortic valves was difficult to visualize (Figure 1). In the apical four-chamber view, the right ventricle was very small and the cystic tumor was in front of it. In this view, the moving cloud-like echoes were also seen in the cystic cavity. The right atrium was markedly enlarged (Figure 2). At operation, a mass lesion suggestive of a coronary aneurysm was found in front of the right ventricle, almost obscuring the whole operative field. The inferior and superior vena cavae were engorged. The right atrium measured approximately 12 cm in diameter and the giant oval cystic lesion measured 13 cm X 15 cm. No blood vessels were found on its surface. Temporal occlusion of both the proximal and distal openings caused no EKG changes, which suggested there were adequate collaterals.Cardiopulmonary bypass was instituted and the cystic tumor decreased in size. It was founc! to be an aneurysm of the right coronary artery containing oxygenated blood arising from the proximal segment of the right coronary artery about 3 cm from its origin. The aneurysm measured 15 cm in diameter and its wall was about 4 mm in thickness. The aneurysmal wall was smooth and no mural thrombus was found. The proximal and distal openings of the aneurysm were about 0.5 cm and 0.2 cm in diameter, respectively. The aneurysm of the right coronary artery wa...

An Extremely Large Coronary Aneurysm Associated with a Quadricuspid Aortic Valve in an Adult Patient

“…Coronary artery aneurysms may be caused by coronary arteritis, congenital malformations, postcoronary interventions and chest trauma (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The aneurysm in the present case was associated with coronary pulmonary artery fistulas and had a short trunk measuring 2-3 mm in length branching from the left anterior descending coronary.…”

“…Making an earlier noninvasive diagnosis of coronary artery aneurysms may be clinically relevant because thromboembolism, rupture and hemodynamic problems related to compression may occur. Echocardiography and multidetector row CT are useful for diagnosing coronary aneurysms (3,16,17). In the present case, transthoracic echocardiography also visualized the giant echolucent mass in the pericardial space; however, transesophageal echocardiography was more useful for precisely visualizing the color Doppler flow into the aneurysm from the donor left anterior descending coronary artery.…”

“…The etiology of coronary aneurysms involves congenital malformation, atherosclerosis, chest trauma, Kawasaki disease, sarcoidosis, Behcet's disease, systemic lupus erythematosus, directional coronary atherectomy and postimplantation of a drug-eluting stent (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Coronary artery fistulas are a common congenital disease that is often combined with giant coronary aneurysms (13).…”

Congenital Giant Aneurysm of the Left Coronary Artery

“…4) Cases where an isolated giant aneurysm is present without any evidence of coronary fistula are very rare. In the recent literature, only few cases of giant congenital coronary artery aneurysm have been published [2][3][4][5]. In all, the anomaly was identified as a formation in the RCA and treated surgically by resection of the target vessel and coronary bypass procedure [6-8] (Table 1).…”

Two giant congenital aneurysms of the left anterior descending coronary artery with right ventricle fistula: Diagnosis based on two‐dimensional echocardiography and magnetic resonance imaging

“…have previously reported about the echocardiographic features of a giant congenital aneurysm of the right coronary artery. 4 In this report, we describe our experience of diagnosing these congenital coronary aneurysms by using the noninvasive techniques of two-dimensional echocardiography and magnetic resonance imaging (MRI). left heart border which was suspected to be an enlarged left auricle (Figure 1).…”