Surgical Treatment of Left Main Coronary Artery Aneurysm A Case Report

Abstract

Circ J 2009; 73: 770 -771 eft main (LM) coronary artery aneurysm is rare, with only 0.1% of adults undergoing coronary angiography. 1 Depending on the clinical scenarios, LM aneurysm can be managed by observation, percutaneous intervention or surgical resection. 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. 3 The coexisting obstructive coronary artery disease plays an important role in making a decision for the operative management in patients with the LM coronary aneurysm. 4 Case ReportA 63-year-old man had a coronary stent for left anterior descending (LAD) coronary artery 1 year before and presented with intermittent exertional chest tightness. The treadmill exercise test showed cardiac ischemia. Cardiac catheterization showed LM coronary aneurysm and 2-vessel disease ( Figure 1A). Multi-slices computed tomography showed significant luminal dilatation of LM coronary artery ( Figure 1B). Surgical resection and revascularization were proposed. Intraopertive transesophageal echocardiography showed a budding chamber from left coronary sinus, which was compatible with LM coronary aneurysm ( Figure 1C). Under cardiopulmonary bypass, coronary artery bypasses of the left internal mammary artery to LAD artery and sequential saphenous vein to ramus intermediate and obtuse marginal branches were constructed in beating-heart manner. The main pulmonary artery was then transected to expose LM coronary aneurysm. The LM coronary aneurysm was carefully dissected ( Figure 1D) and totally excised. The other vein graft was used to bypass proximal LAD, ramus intermediate and circumflex arteries ( Figure 1E). The resected LM coronary aneurysm showed significant atherosclerosis and concentric vessel wall thickening ( Figure 1F). The operation was illustrated in Figure 2. The patient was discharged in good condition. DiscussionCoronary artery aneurysms are defined as dilated segments greater than 1.5 times the diameter of adjacent normal coronary arteries. 5 Among them, LM coronary aneurysm accounted for one-fifth of overall incidence. 6 Most of them are incidental findings during coronary angiography with the intent to search for ischemic heart diseases. Coronary angiography remains the gold standard in the diagnosis of coronary aneurysms. Recent advances of image technologies provide less invasive ways to confirm the diagnosis before an invasive approach. The 64-slices computed tomography provides information regarding the size, shape, location, number and calcification in addition to obstructive coronary artery disease...

Surgical treatment of giant saccular coronary artery aneurysm: a case report

“…Surgical treatment options include patch plasty, distal and proximal aneurysm sac ligation, and graft interposition as well as additional bypass grafting to the accompanying distal atherosclerotic lesions. [3] In our case, patch plasty was not preferred because we saw diffuse atherosclerosis when we opened the aneurysm sac. Continuity of flow to the circumflex artery was maintained after plicating the sac.…”

“…Among all coronary artery aneurysms, lesions of the left coronary Saphen vein interposed between LMCA and LAD artery are seen 20% of the time. Atherosclerosis is the major etiologic factor in the adult population, [3] and it has been postulated by many authors that this rare entity is a variant of coronary artery disease. [4] Our patient had similar findings regarding the presence of diffuse atherosclerotic lesions distal to the aneurysm sac.…”

“…Lin et al [3] presented their case in which the pulmonary artery was transected in order to totally excise the LMCA aneurysm. This was not needed in our case since the aneurysm sac was located further along the course of the LAD artery and could be reach easily.…”

Management of Distal Left Main Coronary Artery Aneurysm

“…LM aneurysms are rare, and only 0.1% of the adults with aneurysms undergo coronary angiography. 1,2 Majority of these aneurysms are atherosclerotic in origin. Other causes of aneurysms include connective tissue disorders, trauma, vasculitis, congenital defects, mycotic infections, and idiopathic conditions.…”