Search

A 59-year-old man was admitted to our hospital because of angina pectoris and a large right coronary aneurysm. Two years previously, he underwent percutaneous coronary balloon angioplasty for a stenotic lesion in right coronary artery (RCA) #3. Angiography and computed tomography showed a large right coronary aneurysm. On-pump coronary artery bypass grafting (CABG), ligation of RCA proximal and distal to the aneurysm, resection of the aneurysm was performed successfully. Postoperative course was uneventful with satisfactory angiographic results.

Background: To follow up coronary arterial lesions due to Kawasaki disease (KD) using noninvasive magnetic resonance coronary angiography (MRCA), we studied a method to improve the quality of images in young children., Method: Non-contrast enhanced, free-breathing MRCA with the vector ECG gating real-time navigator-echo 3D steady-state free precession (SSFP) technique was performed using a 1.5-T whole-body MR imaging system (Philips) in 68 children with KD aged 4 months to less than 6 years. A flex medium coil was used. Data were acquired with a 180 to 200 mm field of view (FOV) and were reconstructed with a 512 x 360 matrix. Patients were sedated during the examination. Many parameters were optimized for each patient; i.e., FOV, acquisition delay, turbo-field echo-factor, navigator-window and resolution, which resulted in the acquisition of high-resolution and high-signal images of the coronary arteries., Results: These conditions remarkably improved not only the quality of the images, but also the detection rate of coronary arterial segments (American Heart Association) in the children. The rates were as follows; Segments 1 (97%), 2 (97%), 3 (87%), 4 (66%), 5 (97%), 6 (96%), 7 (83%), 8 (56%), 9 (53%), 10 (21%), 11 (96%), 12 (29%), 13 (93%), 14 (54%), and 15 (65%)., Conclusion: MRCA is a useful method for evaluation coronary aneurysms from the early stages of KD, even in infants and small children.

The successful surgical treatment for a coronary artery aneurysm was reported. A 38-year-old female presented with angina pectoris due to right coronary artery stenosis. Angiography revealed a right coronary artery aneurysm and 90% stenosis at a site just proximal to the aneurysm, accompanied by the relatively large right ventricular (RV) branch originating from a mid portion of the aneurysm. Off-pump coronary artery bypass grafting (CABG) to the right coronary artery (RCA) #3, translocation of RV branch to RCA #3, and ligation of RCA proximal and distal to the aneurysm were successfully performed. Post-operative course had been uneventful with satisfactory angiographic results. Coronary translocation with CABG could be a treatment option for coronary artery aneurysms.

We report a giant coronary artery aneurysm occurred in the diagonal artery. A 44-year-old woman was referred to our institution for further examination of chest X-ray abnormality. Computed tomography revealed a 6 cm intracardiac mass adjacent to pulmonary artery. Cardiac catheterization revealed a giant coronary artery aneurysm with the large thrombus in the diagonal artery. A giant aneurysm 6 cm in diameter was exposed through a median sternotomy. Under beating heart with cardiopulmonary bypass, the aneurysm was opened and organized thrombus was removed. The influx and efflux of the aneurysm were identified and ligated. Under arrested heart with cardioplegia, the diagonal artery was bypassed with the left internal thoracic artery. Finally the aneurysm was obliterated with the running suture. The patient discharged at the 17th postoperative day without any complications. Histologic evaluation of the resected aneurysm revealed atherosclerotic change, destruction of vascular layers and infiltration of inflammatory cells. These findings suggested previous history of coronary arteritis. The coronary aneurysm in this case might be resulted from Kawasaki disease.

Fractional flow reserve was measured in three patients with coronary artery dissection occurring after percutaneous coronary intervention. In Case 1, fractional flow reserve decreased from 0.88 to 0.73 and angiography showed coronary artery dissection 20 min after balloon angioplasty. In Case 2, angiography showed good results, but the fractional flow reserve decreased to a low value(0.69). Intravascular ultrasonography revealed dissection. In Case 3, angiography clearly showed dissection, but fractional flow reserve remained high(0.91). Stent implantation was performed in all three patients, but might not have been necessary in Case 3. Dissection with low or diminished fractional flow reserve value may cause a pressure gradient in the true lumen. Stent implantation is necessary in such cases. On the other hand, cases of dissection in which the fractional flow reserve value is maintained may also cause a pressure gradient in true lumen, but stent implantation may not be necessary. Fractional flow reserve measurements may be useful for the assessment of coronary artery dissection and evaluating the indications for stent implantation.

A 36-year-old man was hospitalized in December, 1990 because a small R wave was observed on his ECG in V1-3. The patient had suffered from a cold with fever for a month when he was a child. He had no symptoms or signs of myocardial infarction. The patient underwent selective right and left coronary angiography, which revealed specific coronary aneurysms in the left circumflex coronary artery and left anterior descending coronary artery. The aneurysm in the distal lesion of the left circumflex coronary artery was embolized by a thrombus and filled with many capillary arteries. The proximal lesion of the right coronary artery was slightly dilated. Good collateral flow from the right coronary artery to the left coronary artery was revealed by coronary angiography. Left ventriculograms were performed, and the anterior wall motion of the left ventricle was shown to the hypokinetic. A perfusion defect of the anterior wall of the left ventricle was revealed by Thallium-201 imaging with single photoemission computed tomography. Based on these findings, we diagnosed the patients' illness as old myocardial infarction caused by Kawasaki disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary coronary artery dissection occurring as a spontaneous event and not associated with trauma due to catheter manipulation is rare. We recently experienced (a case of) a 52-year-old man with primary artery dissection. He was admitted to our hospital with severe chest pain as his chief complaint on September 6, 1988. Electrocardiography and laboratory data showed acute inferior myocardial infarction. He was treated with medication and underwent coronary angiograms on October 3, 1988. Right coronary angiogram revealed an intimal flap and false lumen. But right coronary angiograms 6 months after the onset of myocardial infarction revealed progression of stenosis but no intimal flap, and coronary spasm was not evoked after acetylcholine administration. Primary coronary artery dissection has been reported since Pretty's first description of it in 1931. The majority of earlier cases were diagnosed at autopsy, but recently reports of survivors have been increasing due to the progress in and popularization of coronary angiographic technics. This case is the 46th case of primary coronary dissection found by coronary angiography. So it is not extremely rare. In our case the involved artery was the right coronary artery. In survivors, right coronary artery dissection is more frequent than left, because the area supplied by the right coronary artery is smaller than the area supplied by the left one. Although in our case coronary artery stenosis progressed, after a long term resolution of dissection may occur. There are a few cases in which resolution of dissection occurred naturally.(ABSTRACT TRUNCATED AT 250 WORDS)