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2.
Rev. bras. cir. cardiovasc ; 36(3): 433-435, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1288244

ABSTRACT

Abstract A 32-year-old man diagnosed with Kawasaki disease at the age of three years presented with coronary artery aneurysm (CAA). The aneurysm increased in size, and the patient was referred to our hospital for surgery. Preoperative computed tomography scan showed a super-giant right CAA and giant left CAAs; surgery was performed. The super-giant right CAA was resected, and the ostium of the right coronary artery was closed; then, coronary artery bypass grafting was performed. The left CAAs were not treated surgically because the risk of rupture was low. Here, we describe the successful surgical treatment of a right super-giant CAA.


Subject(s)
Humans , Male , Child, Preschool , Adult , Coronary Aneurysm/surgery , Coronary Aneurysm/etiology , Coronary Aneurysm/diagnostic imaging , Mucocutaneous Lymph Node Syndrome/complications , Tomography, X-Ray Computed , Coronary Artery Bypass , Coronary Vessels/surgery , Coronary Vessels/diagnostic imaging
4.
Arch. cardiol. Méx ; 89(3): 248-253, jul.-sep. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1149074

ABSTRACT

Resumen Los aneurismas de las arterias coronarias se definen como una dilatación localizada que excede el diámetro normal en 1.5 veces. Esta es una condición poco frecuente, su incidencia varía del 0.3 hasta el 5.3% de las angiografías coronarias. Los aneurismas que exceden cuatro veces el diámetro del vaso normal se consideran gigantes. Estos son aún más raros y se presentan en el 0.02 a 0.2% de todos los casos. Existe controversia en cuanto a su fisiopatología, sin embargo, hasta el 50% de los casos se relacionan con la aterosclerosis. Se diagnostican más frecuentemente entre la sexta y séptima décadas de vida. Las principales manifestaciones clínicas están relacionadas con la cardiopatía isquémica. Respecto a su tratamiento, no existe un consenso del manejo en los pacientes adultos, las opciones son: médico, quirúrgico o intervencionismo. Reportamos la presencia de un aneurisma gigante de la coronaria derecha y ectasia gigante del sistema izquierdo con trombosis activa en un hombre con antecedentes de un aneurisma en la aorta abdominal, tratado por vía endovascular, e infarto agudo al miocardio sin elevación del segmento ST no reperfundido. Requirió de estudio de angiotomografía coronaria, el cual permitió la identificación de las características anatómicas de esta enfermedad.


Abstract Coronary artery aneurysms are described as a localized dilatation that exceeds the normal diameter by 1.5 times. This is a rare condition; its incidence varies from 0.3% up to 5.3% of all coronary angiographies. Those aneurysms that exceed 4 times the diameter of a normal artery are considered giant aneurysms, which are even more uncommon, presenting between 0.02% and 0.2% of all cases. There is controversy regarding its pathophysiology, however, up to 50% of the cases are related to atherosclerosis. They are diagnosed more frequently between the sixth and seventh decade of life. The main clinical manifestations are related to ischemic heart disease. Regarding their treatment, there is no general consensus towards its management in adult patients. The options are medical, surgical or percutaneous treatment. We report the presence of a giant aneurysm of the right coronary artery and giant ectasia of the left coronary system with active thrombosis in a man with history of an abdominal aortic aneurysm, with endovascular treatment and a non-ST segment elevation myocardial infarction with no reperfusion strategy, who required a coronary computed tomography, identifying the anatomical characteristics of this disease.


Subject(s)
Humans , Male , Aged , Thrombosis/diagnostic imaging , Coronary Aneurysm/diagnostic imaging , Tomography, X-Ray Computed , Aortic Aneurysm, Abdominal/therapy , Dilatation, Pathologic/diagnostic imaging , Non-ST Elevated Myocardial Infarction/physiopathology
6.
Rev. bras. cir. cardiovasc ; 34(1): 111-113, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985232

ABSTRACT

Abstract We report a case of a 23-year-old man who was diagnosed with Kawasaki disease that progressed to a coronary aneurysm in the left main coronary artery (LMA). He had suffered from acute coronary syndrome and then underwent an emergent percutaneous coronary angioplasty, in which a polyurethane-covered stent was placed inside the aneurysm. The stent was thrombosed one year later, despite the patient had been treated with anticoagulant and antiplatelet therapy. Emergency percutaneous intervention was then performed. LMA was reopened and stent malposition was observed. Therefore, urgent coronary bypass grafting was performed in which a high degree of competitive flow was observed through the reopened stent. LMA was ligated at the inflow of the aneurysm, resulting in an improvement of graft flow. Left main ligature has not been previously reported.


Subject(s)
Humans , Male , Young Adult , Coronary Aneurysm/surgery , Coronary Aneurysm/etiology , Coronary Artery Bypass/methods , Mucocutaneous Lymph Node Syndrome/surgery , Mucocutaneous Lymph Node Syndrome/complications , Coronary Aneurysm/diagnostic imaging , Treatment Outcome , Acute Coronary Syndrome/surgery , Computed Tomography Angiography/methods , Ligation , Mammary Arteries/surgery
10.
Rev. chil. cardiol ; 34(3): 190-195, 2015. tab
Article in Spanish | LILACS | ID: lil-775487

ABSTRACT

La enfermedad de Kawasaki es una vasculitis sistémica de vasos de mediano calibre, que afecta principalmente a las arterias coronarias, provocando dilatación y aneurismas coronarios en un 15 - 25% de los casos no tratados. El tratamiento recomendado actualmente es el uso de inmunoglobulina intravenosa antes del décimo día de enfermedad, lo cual reduce el riesgo de aneurismas coronarios de un 20% a un 4%. Objetivos: Determinar la relación entre el tratamiento oportuno con inmunoglobulina y el riesgo de presentar alteración coronaria en la ecocardi ografía en pacientes con Enfermedad de Kawasaki. Métodos: Se revisó la base de datos de Cardiología Infantil del hospital, identificando 66 pacientes que presentaron la enfermedad entre los años 1994 y 2014. Se determinó el momento en que se inició el tratamiento con inmunoglobulina y se analizó el hallazgo ecocardiográfico de alteraciones coronarias durante el período de hospitalización. Resultados: 52 niños (79%) recibieron tratamiento precoz, antes de 10 días del comienzo de la enfermedad; en el resto el tratamiento fue tardío. El tratamiento precoz se asoció a un menor riesgo de presentar aneurismas coronarios (5.8% vs 50% de los casos, p<0.01). Conclusión: En la enfermedad de Kawasaki es de suma importancia el diagnóstico y tratamiento oportuno con inmunoglobulina intravenosa para reducir el riesgo de formación de aneurismas coronarios.


Kawasaki’s disease is a systemic vasculitis of the mediumsized blood vessels, primarily affecting the coronary arteries, causing coronary dilation and aneurysms in 15 - 25% of untreated children. Use of Intravenous immunoglobulin within the first 10 days of illness is the recommended treatment, redugin the risk of coronary artery aneurysm develo-pment from 20% to 4%. Objective: To determine the association of early treatment to risk of echocardiographic coronary changes on patients with the disease. Methods and Results: A review of the institutional Pediatric Cardiology Database, allowed the identification of 66 patients who had Kawasaki’s disease between 1994 and 2014. The echocardiographic findings at follow up were related to the time of treatment initiation in relation to the beginning of the disease. Treatment with im-munoglobulin within 10 days was associated to coronary artery aneurysms in 5.8% of patients, as opposed to 50% in those with a delayed initiation of therapy. Conclusión: Early treatment with immunoglobulins (within 10 days of illness) significantly reduces the short term risk of developing coronary aneurysms in patients with Kawasaki’s disease.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Coronary Aneurysm/prevention & control , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Mucocutaneous Lymph Node Syndrome/drug therapy , Time Factors , Coronary Aneurysm/diagnostic imaging , Echocardiography , Retrospective Studies , Coronary Disease/prevention & control , Mucocutaneous Lymph Node Syndrome/diagnostic imaging
11.
Ann Card Anaesth ; 2012 Jul; 15(3): 240-243
Article in English | IMSEAR | ID: sea-139680

ABSTRACT

A 65-year-old woman presented with a history of dyspnea and atypical chest pain. She was diagnosed with a non-ST-segment elevation myocardial infarction due to a giant right coronary artery aneurysm. After a failed percutaneous embolization, she was scheduled for right coronary artery aneurysm resection, posterior descending artery revascularization and mitral valve repair. During the induction of anesthesia and institution of mechanical ventilation, the patient suffered cardiovascular collapse. The transesophageal echocardiographic examination revealed tamponade physiology owing to compression of the cardiac chambers by the unruptured aneurysm, which resolved with the sternotomy. The surgery was carried out uneventfully.


Subject(s)
Aged , Coronary Aneurysm/surgery , Coronary Aneurysm/diagnostic imaging , Echocardiography, Transesophageal/methods , Female , Humans , Monitoring, Intraoperative
15.
Indian Heart J ; 2005 Jul-Aug; 57(4): 350-2
Article in English | IMSEAR | ID: sea-3306

ABSTRACT

Spontaneous dissection of coronary arteries is an uncommon entity with varied presentation. It is commoner in young patients, specially females. We present three cases encountered by us in recent past. There were two males and the only female was in her post-partum period. All the three had diverse lines of management based on the angiographic picture, clinical background and myocardium at risk.


Subject(s)
Adult , Aneurysm, Dissecting/diagnostic imaging , Coronary Aneurysm/diagnostic imaging , Coronary Angiography , Female , Humans , Male , Middle Aged , Puerperal Disorders/diagnostic imaging
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