Left Main Coronary Artery Aneurysm in Takayasu Arteritis

Abstract

An 18-year-old lady, a patient of Takayasu arteritis was referred to our hospital with a history of recurrent giddiness and resistant hypertension for 6 months. On examination, she had weak left carotid and left arm pulses and bilateral renal bruit. Investigations revealed bilateral renal artery stenosis with preserved renal size and architecture. Transthoracic echocardiogram (TTE) showed concentric left ventricular hypertrophy with ejection fraction of 50% and type I diastolic dysfunction. The aortic

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

“…Patients with atherosclerotic aneurysms of the descending aorta are at elevated risk for coronary atherosclerosis, particularly if they have multiple atherosclerotic risk factors. While patients with Type A dissection or annuloaortic ectasia may be protected from atherosclerosis (383), patients with Takayasu arteritis may occasionally have inflammatory coronary involvement with coronary aneurysms (less than 10%) (384,385). Similarly, an occasional patient with GCA may have coronary artery involvement (386,387).…”

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients with Thoracic Aortic Disease

“…The frequency of coexisting CAD varies widely among patient subgroups with thoracic aortic disease as does the 383 patients with Takayasu arteritis may occasionally have inflammatory coronary involvement with coronary aneurysms (less than 10%). 384,385 Similarly, an occasional patient with GCA may have coronary artery involvement. 386,387 If ascending aortic surgery is being considered, with or without aortic valve surgery, then identification of the coronary anatomy and any underlying CAD is important for planning the best operation.…”

Clinical and angiographic features of large left main coronary artery aneurysms

“…Coronary angiography is the gold standard in the diagnosis of coronary aneurysm, and not only provides information regarding the size, shape, location, and number of aneurysms, but also delineates the presence or absence of associated stenosis. The large coronary artery aneurysms can also be detected by noninvasive imaging modalities such as transesophageal echocardiography, contrast-enhanced computed tomography and magnetic resonance imaging [6][7][8]14,21,28]. All of our patients applied to the hospital with ischemic symptoms, and were performed transthoracic echocardiography that could not demonstrate LMCA aneurysm.…”

“…Majority of coronary artery aneurysms are atherosclerotic in origin, especially those appearing later in the life [1]. However, they may be congenital [6] or may develop secondary to mucocutaneous lymph node syndrome (Kawasaki disease) [7,8]; connective tissue diseases such as Ehler-Danlos, Marfan [9], ankylosing spondylitis [10]; arteritis such as syphilis, systemic lupus erythematosus, Behçet disease [11][12][13] and Takayasu arteritis [14][15][16]; mycotic emboli, trauma, angioplasty, laser procedures, atherectomy, coronary artery bypass graft operation [17], dissection and some rare genetic disorders such as hereditary hemorrhagic telangiectasia [18]. In an autopsy review of 89 cases of coronary artery aneurysm, 52% were atherosclerotic, 17% congenital, 11% mycotic-embolic, 11% dissecting and 4% syphilitic [19].…”