IMAGE FOCUS
doi:10.1093/ehjci/jex161
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Giant triple coronary artery aneurysms Veraprapas Kittipibul1,2, Tunchanok Prapad3, and Sarinya Puwanant1,2* 1
Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330 Thailand; Section of Cardiology, Cardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330 Thailand; and 3 Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330 Thailand 2
* Corresponding author. Tel: 166 83656651; Fax: 0 2256 4291 (Ext. 200). E-mail: [email protected]
A 59-year-old man was referred for an echocardiogram because of asymptomatic enlarged cardiac silhouette on chest radiograph (Panel A). An echocardiogram revealed a large circular echo density in the atrioventricular groove suggestive of left circumflex (LCX) coronary artery aneurysm (Panel B, LCX*, see Supplementary data online, Video S1), a giant circular extra-cardiac echo density (Panel B, RCA**, see Supplementary data online, Video S1) with intraluminal laminated thrombus (Panel B, white arrowheads) compressing right atrial inflow, and a cystic aneurysmal change (Panel C, RCA*, see Supplementary data online, Video S2) in the proximal right coronary artery (RCA) (Panel C, black arrowheads). He had left ventricular ejection fraction of 40%. A coronary computed topographic angiogram (CCTA) demonstrated coronary aneurysms of proximal RCA (Panel D, RCA*) and mid RCA (Panel D–F, RCA**), the maximal diameter measured 110 mm with thrombus-filled lumen. Additionally, a 60-mm left anterior descending artery (LAD) aneurysm (Panel E and F, LAD*) and a 54-mm LCX aneurysm (Panel E and F, LCX*) were demonstrated. A coronary angiogram confirmed aneurysms of RCA (Panel G, see Supplementary data online, Video S3), LAD, and LCX (Panel H, see Supplementary data online, Video S4). Given an extremely large aneurysmal size and LV systolic dysfunction, the patient underwent coronary bypass graft surgery and aneurysmal repair and ligation. Giant coronary artery aneurysm (CAA), aneurysmal size >20 mm, is rare. The most common cause of CAA is atherosclerosis followed by Kawasaki’s disease. The other aetiologies include mycotic cause, vasculitis, and connective tissue disease. This case highlights that multiimaging modalities, including echocardiogram, CCTA, and coronary angiogram, are helpful for diagnosis of CAA and guiding surgical planning. Supplementary data are available at European Heart Journal—Cardiovascular Imaging online.
C The Author 2017. For permissions, please email: [email protected]. Published on behalf of the European Society of Cardiology. All rights reserved. V
doi:10.1093/ehjci/jex161
....................................................................................................................................................
Giant triple coronary artery aneurysms Veraprapas Kittipibul1,2, Tunchanok Prapad3, and Sarinya Puwanant1,2* 1
Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330 Thailand; Section of Cardiology, Cardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330 Thailand; and 3 Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330 Thailand 2
* Corresponding author. Tel: 166 83656651; Fax: 0 2256 4291 (Ext. 200). E-mail: [email protected]
A 59-year-old man was referred for an echocardiogram because of asymptomatic enlarged cardiac silhouette on chest radiograph (Panel A). An echocardiogram revealed a large circular echo density in the atrioventricular groove suggestive of left circumflex (LCX) coronary artery aneurysm (Panel B, LCX*, see Supplementary data online, Video S1), a giant circular extra-cardiac echo density (Panel B, RCA**, see Supplementary data online, Video S1) with intraluminal laminated thrombus (Panel B, white arrowheads) compressing right atrial inflow, and a cystic aneurysmal change (Panel C, RCA*, see Supplementary data online, Video S2) in the proximal right coronary artery (RCA) (Panel C, black arrowheads). He had left ventricular ejection fraction of 40%. A coronary computed topographic angiogram (CCTA) demonstrated coronary aneurysms of proximal RCA (Panel D, RCA*) and mid RCA (Panel D–F, RCA**), the maximal diameter measured 110 mm with thrombus-filled lumen. Additionally, a 60-mm left anterior descending artery (LAD) aneurysm (Panel E and F, LAD*) and a 54-mm LCX aneurysm (Panel E and F, LCX*) were demonstrated. A coronary angiogram confirmed aneurysms of RCA (Panel G, see Supplementary data online, Video S3), LAD, and LCX (Panel H, see Supplementary data online, Video S4). Given an extremely large aneurysmal size and LV systolic dysfunction, the patient underwent coronary bypass graft surgery and aneurysmal repair and ligation. Giant coronary artery aneurysm (CAA), aneurysmal size >20 mm, is rare. The most common cause of CAA is atherosclerosis followed by Kawasaki’s disease. The other aetiologies include mycotic cause, vasculitis, and connective tissue disease. This case highlights that multiimaging modalities, including echocardiogram, CCTA, and coronary angiogram, are helpful for diagnosis of CAA and guiding surgical planning. Supplementary data are available at European Heart Journal—Cardiovascular Imaging online.
C The Author 2017. For permissions, please email: [email protected]. Published on behalf of the European Society of Cardiology. All rights reserved. V
