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Multiple giant coronary aneurysms: a rare form of coronary artery disease
Session:
Casos Clínicos: Cardiologia de Intervenção
Speaker:
Joana Lima Lopes
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
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Subtheme:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Joana Lima Lopes; Sérgio Bravo Baptista; Pedro Magno; Ana Rita Ferreira; João Bicho Augusto; Pedro Farto e Abreu
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-family:"Times New Roman",serif">A 63-year-old male, with a past medical history of diabetes, hypertension and atrial fibrillation, presented to the Cardiology clinic with complaints of typical chest pain on exertion. This had been happening for the past 4 months. He was previously medicated with ramipril 5mg o.d. and metformin 1000mg b.i.d. He had an unremarkable ECG and transthoracic echocardiogram. The patient was initiated on antianginal drugs and was further referred for an elective coronary angiography. <span style="color:black">The coronary angiography was performed and showed </span>multiple giant aneurysms of both coronary arteries (panels A and B). A computed tomography coronary angiography was performed confirming the presence of multiple coronary aneurysms, the largest on the right coronary artery (RCA) (45mm), followed by the left anterior descendant (LAD) (17mm) and circumflex (Cx) (15mm) arteries (Panel C). A cardiac magnetic resonance scan was performed for further characterization, showing the presence of thrombi in the luminal cavity of the aneurysms (Panels D and E). Giant coronary aneurysms are an extremely rare finding (0.02%). Atherosclerosis is the main cause (50%), however when both coronary arteries are involved, Kawasaki’s disease is the most frequent etiology. <span style="background-color:white"><span style="color:black">The termed “giant” is applied when the dilated segment is either > 8 mm in diameter or 400% of the diameter of the adjacent segments, as shown in this case. Our patient presented with typical chest pain which is believed to be a consequence of either myocardial ischemia, microvascular disease, myocardial infarction from a low flow state, thrombosis or distal embolization (or due to a combination of factors).</span></span> <span style="background-color:white"><span style="color:black">Although the natural history of giant aneurysms is not known, severe complications can emerge such as rupture, fistulation, or compression of adjacent structures and for that reason surgical treatment is advised. The case was discussed in Heart Team and cardiac surgery was considered the best option for our patient. </span></span><span style="color:black">We increased the patient’s anti-anginal drug therapy, and a complete clinical response (no symptoms of chest pain) was noted during follow-up. The patient is currently awaiting heart surgery in a non-urgent calendar. </span>Giant coronary aneurysms </span><span style="font-family:"Times New Roman",serif">are an extremely rare finding.<sup> </sup>Their natural history is unknown, but the potential risk for complications makes surgical treatment the most advisable approach with surgical ligation and distal bypass being strategies to consider.</span></span></span></span></p>
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