Coronary artery aneurysms are detected with increasing frequency owing to the advent of coronary angiographies. Although most patients with coronary artery aneurysms are asymptomatic, manifestations of myocardial ischemia may occur. The case described herein serves as a basis for a discussion of the pathogenesis, clinical manifestations, detection, and treatment of coronary artery aneurysms.
Get full access to this article
View all access options for this article.
References
1.
Falsetti HL, Carroll RJ: Coronary artery aneurysm, a review of the literature with a report of 11 new cases. Chest69:630-636, 1976.
2.
Markis JE, Jofee CD, Cohn PF, et al: Clinical significance of coronary ectasia. Am J Cardiol37:217-222, 1976.
3.
Alford WC, Stoney WS, Burrus GR, et al: Recognition and operative management of patients with arteriosclerotic coronary artery aneurysms. Ann Thor Surg22:317-321, 1976.
4.
Befeler B., Aranda JM, Embi A., et al: Coronary artery aneurysms: Study of the etiology, clinical course and effect on left ventricular function and prognosis. Am J Med62:597-607, 1977.
5.
Swanton RH, Thomas ML, Coltart D., et al: Coronary artery ectasia—a variant of occlusive coronary arteriosclerosis. Br Heart J40:393-400, 1980.
6.
Aintablian A. , Hamby RI, Hoffman I., et al: Coronary ectasia: Incidence and Results of coronary bypass surgery. Am Heart J96:308-315, 1978.
Hartnell GG, Parnell BM, Pridie RB: Coronary artery ectasia: Its prevalence and clinical significance in 4993 patients. Br Heart J54:392-395, 1985.
9.
Daoud AS, Pankin D., Tulgan H., et al: Aneurysms of the coronary artery. Am J Cardiol43:228-237, 1963.
10.
Holsinger DR , Osmundson PJ, Edwards JE: The heart in periarteritis nodosa. Circulation25:610-618, 1962.
11.
Crocker DW, Sobiun S., Thomas WC: Aneurysms of the coronary arteries: Report of three cases in infants and review of the literature. Am J Pathol33:819-843, 1957.
12.
Kurokowa H. , Kondo T., Shiga Y., et al: Myocardial infarction due to thrombi in coronary artery aneurysms in a young woman with systemic lupus erythematosus . J Cardiography16:249-258, 1986.
13.
Chaithiraphan S., Goldberg E., O'Reilly M., et al: Multiple aneurysms of coronary artery in scleroderma heart disease. Angiology24:86-93, 1973.
Konecke LL, Spitzer S., Mason D., et al: Traumatic aneurysm of the left coronary artery. Am J Cardiol27:221-221, 1971.
16.
Bjrn-Hansen LS, Thomassen AR, Nielsen TT: Aneurysm of the left anterior descending coronary artery after chest trauma. Eur Heart J10:177-179, 1989.
17.
Wang SP, Shyong WC, Tsai JH, et al: Development of posttraumatic coronary aneurtsm: Clinical implications . Am Heart J115:1306-1307, 1988 .
18.
Vassanelli C., Turri M., Morando G., et al: Coronary artery aneurysm after percutaneous transluminal coronary angioplasty—a not uncommon finding at elective follow-up angiography. Int J Cardiol22:151-156, 1989.
Weno T., Itoh T., Ntsuaki M., et al: Surgical treatment of coronary artery aneurysm developed after PTCA. ThorCardiovasc Surg36:46-48, 1988.
21.
Sandoshima J., Nakamura Y., Taira Y., et al: A case of primary dissecting aneurysm of the coronary artery. Jpn Heart J28:799-804, 1987.
22.
Harruffv RC , Ferrall CL, Hagan J., et al: Dissecting aneurysm of the coronary artery. J Tenn Med Assoc80:603-604, 1987.
23.
Nishikawa H. , Nakanishi S., Nishuyama S., et al: Primary coronary artery dissection observed at coronary angiography. Am J Cardiol61:645-648, 1988.
24.
Ellis R., Kurth RJ: Calcifiedx coronary artery aneurysms. JAMA203:51-53, 1968.
25.
Imahori S., Bannerman RM, Graf CJ, et al: Ehlers-Danlos syndrome with multiple arterial lesions. Am J Med47:967-977, 1969.
26.
Di Mario C., Zanchetta M., Maiolini P.: Coronary artery aneurysm in a case of Ehlers-Danlos syndrome. Jpn Heart J29:491-496, 1988.
27.
Potkin BN, Hoeg JM, Connor WE, et al: Aneurysmal coronary artery disease in cerebrotendinous xanthomatosis . Am J Cardiol61:1150-1152, 1988 .
28.
van derWall EE, Padmos I., Catrs V.: Coronary arterial aneurysm: possible relation with malaria. Int J Cardol21:351-353, 1988.
29.
Kandarpa K., Stoll JF, Reiss C.: A case of neurofibromatosis associated with coronary artery aneurysm and myocardial infarction. Cardiovasc Intervent Radiol11:143-145, 1988.
30.
Morgagni JB: De Sedibus et Causis Morborum. Venice, 1761. Vol 1, book 2, epist 27, art 28. Quoted by Falsetti and Carroll (1).
31.
Holman E., Peniston W.: Hydrostatic factors in the production of aneurysms. Am J Surg90:200-209, 1955.
32.
Rodbard S., Ikeda K., Montes M.: An analysis of mechanisms of poststenotic dilatation. Angiology18:349-369, 1967.
33.
Mozen, HE: Congenital cirsoid aneurysm of a coronary artery with associated arterio-atrial fistula, treated by operation. Ann Surg144:215-217, 1956.
34.
Sebra-Gomes R., Sommerville J., Ross DN, et al: Congenital coronary aneurysms. Br Heart J36:329, 1974.
35.
Belsky H., Sharnoff JG, Gilbert S.: Aneurysm of the coronary artery. NY State J Med55:3151-3152, 1955.
36.
Fritz G., Cullhed I., Bjork L.: Congenital localized coronary artery aneurysm without fistula. Am Heart J76:674-679, 1968.
37.
Schultz TC: Coronary artery aneurysms in young adults. m J Forensic Med Pathol10:63-66, 1989.
38.
Packard M., Weschler H.: Aneurysms of the coronary arteries. Arch Intern Med43:1-14, 1929.
Kitamura S. , Kawashima Y., Miyamoto K., et al: Multiple coronary aneurysms resulting in myocardial infarction in a young man. J ThoacCardiovasc Surg70:290-297, 1975.
43.
McMartin DE , Stone AJ, FRanch RH: Multiple coronary-artery aneurysms in a child with angina pectoris. Engl J Med290:669, 1974.
44.
Ebert PA, Peter RH, Gunnells JC, et al: Resecting and grafting of coronary artery aneurysm. Circulation43:593-598, 1971.
45.
Herman MV, Heinle RA, Klenin MD, et al: Localized disorders in myocardial contraction. N Engl J Med277:222, 1967.
46.
Hamilton GW , urray JA, Kennedy JW: Quantitative angiography in ischemic heart disease. The spectrum of abnormal left ventricular function and the role of abnormally contracting segments. Circulation45:1065-1080, 1972.
47.
Lim CH, Tan HC, Tan L., et al: Giant congenital aneurysm of the right coronary artery. Am J Cardiol39:751-755, 1977.
48.
Zoneraich S. , Zoneraich O., Rhee JJ, et al: Giant coronary aneurysm: Cause of middiastolic murmur and bulging of the left cardiac border. JAMA231:179, 1975.
49.
Ghahrani A. , Iyengar R., Cunha D., et al: Myocardial infarction due to congenital coronary arterial aneurysm (with successful saphenous vein bypass graft). Am Cardiol29:863, 1972.
50.
Doi YL, Hamashige N., Odawara H., et al: Ring-calcification of coronary artery aneurysms in an adolescent . Chest92:1118-1120, 1987 .
51.
Kawasaki T. : Acute febrile mucocutaneous lymph node syndrome: Clinical observations of 50 cases. Jpn J Allergol16:178, 1967.
52.
Morens DM, Anderson L., Hurwittz ES: National surveillance of Kawasaki disease. Pediatrics65:21-25, 1980.
53.
Kato, Ichinose E, Kawasaki T.: Myocardial infarction in kawasaki disease: Clinical analysis of 195 cases. Pediatr108:923-927, 1986.
54.
Kato H., Ichinose E., oshioka F., et al: Fate of coronary artery aneurysms in Kawasaki disease: Serial coronary angiography and long term follow-up study. Am J Cardiol49:1758-1766, 1982.
55.
Suzuki A., Kamiya T., Kuwahara N., et al: Coronary arterial lesions in Kawasaki disease: Cardiac catheterization findings in 1100 cases. Pediatr Cardiol7:3-9, 1986.
56.
Herold BC, Davis AT, Arroyave CM, et al: Cryoprecipitates in Kawasaki syndrome: Association with coronary artery aneurysms. Pediatr Infect Dis J7:255-257, 1988.
57.
Ichida F., Fatica N., Engle MA, et al: Coronary artery involvement in Kawasaki syndrome in Manhattan , New York: Risk factors and role of aspirin. Pediatrics80:828-835, 1987.
58.
Newburger JW , Takahashi M., Burns JC, et al: The treatment of Kawasaki disease with intravenous gamma globulin. N Engl J Med315:341-347, 1986.
59.
Takahashi M. , Mason W., Lewis AB: Regression of coronary aneurysms in patients with Kawasaki syndrome. Circulation75:387-394, 1987.
60.
Fujiwara T, Fujiwara, Hamashima Y Size of coronary artery aneurysm as a determinant factor for the prognosis in Kawasaki disease: Clinicopathologic study of coronary artery aneurysms. Prog Clin Biol Res250:519-520, 1987.
61.
Nakano H., Ueda K., Saito A., et al: Repeated quantitative angiograms in coronary artery aneurysms in Kawasaki disease. Am J Cardiol56:846-851, 1985.
62.
Tatara K., Kusakawa S.: Long term prognosis of giant coronary aneurysms in Kawasaki disease: An angiographic study. Pediatr111:705-710, 1987.
63.
Tatara K., Kusakawa S.: Long term prognosis of giant coronary aneurysms in Kawasaki disease: Prog Clin Biol Res250:579, 1987.
Vered Z., Kat M., Rath S., et al: Two dimensional echocardiographic analysis of proximal left main coronary artery in humans. Am Heart J112:972-977, 1986.
66.
Tunick PA, Slater J., Pasternack P., et al: Coronary artery aneurysm: A transesophageal echocardiographic study. Am Heart J118:176-79, 1989.
67.
Capannari TW, Daniels SR, Meyer RA, et al: Sensitivity, specificity and predictive value of two-dimensional echocaorodiography in detecting coronary artery aneurysms in patients with Kawasaki disease. J Am Coll Cardiol7:355-360, 1986.
68.
Bisset GS, Strife JL, McCloskey J.: MR imaging of coronary artery aneurysm in a child with kawasaki disease. Am J Radiol152:805-807, 1989.
69.
Laurent F., Drouillard J., Dorcier F., et al: CT appearance of coronary aneurysm in Kawasaki disease. J Comput Assist Tomgr11:151-52, 1987.
70.
Frey EE, Matherne GP, Mahoney LT, et al: Coronary artery aneurysms due to Kawasaki disease: Diagnosis with ultrafast CT. Radiology167:725-726, 1988.
71.
Glanz S., Bittner SJ, Berman MA, et al: Regression of coronary artery aneurysms in infantile polyarteritis nodosa. N Engl J Med294:939-941, 1976.
72.
Pickard CM, Owen CJ, Dammin GJ: Aneurysms of the coronary arteries due to polyarteritis nodosa occurring in infants: Report of a c ase with coronary artery thrombosis and myocardial infarction. J Lab Clin Med32:1513, 1947.
73.
:iddicoat JE , Bekassy SM, O'Donnell, et al: Coronary artery aneurysm in a 9-year-old child. Surgery76:845, 1974.
74.
Robertson T. , Fisher L.: Prognostic significance of coronary artery aneurysm and ectasia in the Coronary Artery Surgery Study (Cass) registry . Prog Clin Biol Res250:325-339, 1987.
75.
Tibbits P., Stanton K., Ashworth H., et al: Congenital coronary artery aneurysm nine years following saphenous vein bypass graft surgery. Ann Thor Surg32:411, 1981.
76.
Mattern AL, Baker WP, McHale J., et al: Congenital coronary artery aneurysms with angine pectoris and myocardial infarction treated with saphenous vein bypass graft. Am J Cardiol30:906-909, 1972.
77.
Suma, Takeuchi Y, Shiroma K., et al: Early and late postoperative studies in coronary arterial lesions resulting from Kawasaki disease in children. J Thorac Cardiovasc Surg84:224-229, 1982.
78.
Suzuki A., Kamiya T., Ono Y., et al: Indication of aortocoronary bypass for coronary arterial obstruction due to Kawasaki disease. Heart and Vessels1:94-100, 1985.
79.
Pintar K., Barboriak JJ, Johnson D., et al: Atherosclerotic aneurysm in aortocoronary vein graft. Arch Pathol Lab Med102:287-288, 1978.
80.
Riahi M., Vasu M., Tomatis LA, et al: Aneurysm of saphenous vein bypass graft to coronary artery. J Thorac Cardiovasc Surg70:358-359, 1975.
81.
Benchimol A. , Harris CL, Desser KB, et al: Aneurysms of an aorto-coronary artery saphenous vein bypass graft—a case report. Vasc Surg9:261-264, 1975.
82.
Yousem D., Scott W., Fishman EK, et al: Saphenous vein graft aneurysms demonstrated by computed tomography. CompAssist Tomogr10:526-528, 1986.
83.
Bramlet DA, Behar VS, Ideker, RE: Aneurysm of a saphenous vein bypass graft associated with aneurysms of native coronary arteries. Cath Cardiovasc Diag8:489-494, 1982.
84.
Shapeero LG , Guthaner DF, Swerdlow CD, et al: Rupture of a coronary bypass graft aneurysm: CT evaluation and coil occlusion therapy. Am J Radiol141:1060-1062, 1983.
85.
Taliercio CP , Smith HC, Pluth JR, et al: Coronary artery venous bypass graft aneurysm with symptomatic coronary artery emboli. J Am Coll Cardiol7:437-437, 1986.
86.
Teja K., Dillingham R., Mentzer RM: Saphenous vein aneurysms after hyperlipidemia as determining factors. Am Heart J113:1527-1529, 1987.
87.
Liang BT, Antman EM, Taus R., et al: Atherosclerotic aneurysms of aortocoronary vein grafts. Am J Cardiol61:185-188, 1988.