Left main coronary artery aneurysm with chronic total occlusion of both left coronary arteries in a young athlete

Abstract

Aneurysms of the left main coronary arteries are found in 0.1% of angiograms. This case involves an athlete with a left main coronary artery aneurysm, which was combined with chronic total occlusion of the proximal left anterior descending and proximal left circumflex coronary arteries. The extraordinary clinical presentation in this patient may be associated with good coronary collaterals, which may have developed in the patient in response to chronic total occlusion of the coronary artery by the aneurysm, and repeat myocardial hypoxia during high levels of performance as a soccer player. (Heart 2001;85:e1) Keywords: coronary aneurysm; left main coronary disease; intravascular ultrasonography; electron beam computed tomography Left main (LM) coronary artery aneurysm is very rare, occurring in 0.1% of adults undergoing coronary angiography.1 Although some of these cases had associated multivessel coronary artery disease, to the best of our knowledge there has been no previous report of an LM coronary aneurysm associated with chronic total occlusion of the left anterior descending (LAD) and left circumflex (LCx) arteries at the osteum. Such findings in a young soccer player, together with a review of the possible causes, are presented here. Case reportA 31 year old man was admitted to the coronary care unit following a non-Q wave myocardial infarction which had occurred two hours earlier. He had been a soccer player since childhood and had played regularly up until a year ago. He had no risk factors for coronary artery disease and no unusual history. His physical examination was normal. Laboratory examinations, including erythrocyte sedimentation rate, C reactive protein, complete blood count, serologic test for syphilis, rheumatoid factor, antinuclear antibody, antithrombin III, protein C, and protein S, were normal. Echocardiography showed a greatly dilated LM coronary artery and mild hypokinesia at the left ventricular apex. Fluoroscopy and coronary angiography revealed a calcified giant aneurysm of the LM artery with total occlusion of the LAD and LCx arteries at the osteum ( fig 1), with good collaterals from the normal right coronary artery (RCA). Angiographies, including the cerebrovascular and peripheral arteries, were normal. Electron beam computed tomography (EBCT) confirmed the presence of a 3.0 × 1.5 cm lobulated cystic lesion with a calcification rim from the LM to the LAD and LCx coronary arteries (fig 2A). Intravascular ultrasonography (IVUS) revealed a fusiform giant aneurysm of the LM artery ( fig 2B) and a severe intimal thickening at the osteum of the LAD artery with calcification ( fig 2C). The patient underwent coronary artery bypass surgery and was discharged in a good condition. DiscussionAneurysms of the LM coronary artery are rare.1 Most reported cases of LM artery aneurysms were incidentally noticed at coronary angiography for evaluation of myocardial ischaemic symptoms. As our case presented with a small myocardial infarction, considering the regional wall motion abnormality...

Surgical Treatment of Coronary Artery Aneurysm with Calcification and Stenosis: A Case Report and Review of the Literature

“…Especially for patients with normal distal vessels, coronary artery bypass grafting is the preferred treatment [1,2] . According to the summary of all cases with CAA calci cation and stenosis [2,10,12,13,22,[26][27][28][29][30][31][32][33][34][35][36][37][38] (Table 1), surgical treatment based on CABG can effectively solve the problem of CAA calci cation and stenosis. Unfortunately, all reports have no long-term follow-up results.…”

The young man with a stenocardial acute chest pain

“…The main ones are as follows: atherosclerosis, mucocutaneous lymph node syndrome, autoimmune diseases, trauma, dissection, iatrogenic complications, syphilis, and mycotic emboli. 1 The damage caused by the disease can progress and be present in the adult age group, and therefore Kawasaki disease should be included in the differential diagnosis of ischaemic cardiac disease. It is important, especially in young patients without other risk factors.…”

“…There are several reasons for the formation of coronary aneurysms. The main ones are as follows: atherosclerosis, mucocutaneous lymph node syndrome, autoimmune diseases, trauma, dissection, iatrogenic complications, syphilis, and mycotic emboli 1 …”

Surgical Treatment of Left Main Coronary Artery Aneurysm A Case Report

“…Atherosclerosis, mucocutaneous lymph node syndrome, autoimmune diseases (systemic lupus erythematosus, periarteritis nodosa or types of arteritis), trauma, dissection, iatrogenic complications (angioplasty, atherectomy, laser procedures), syphilis and mycotic emboli are all possible causes of coronary aneurysms. 2 Surgery should be considered for large LM coronary aneurysms because of the risks of thrombosis and embolism. In fact, aneurysmal coronary artery disease should be considered a variation of coronary artery disease, with which it usually coexists.…”