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Giant coronary artery aneurysm with fistula to the pulmonary artery complicated by frequent ventricular premature contractions: a case report.

Cao H, Ye L, Chan P, Fan H, Liu Z - Medicine (Baltimore) (2015)

Bottom Line: The main pulmonary artery was opened longitudinally and the fistula was also closed directly.The patient's symptoms of frequent ventricular premature contractions disappeared postoperatively as confirmed by electrocardiography.Although the standard therapeutic strategies of the disease are not well established because of the rarity of this condition, our clinical results indicate that the surgical treatment is an effective choice.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiovascular Surgery (HC, LY, HF, ZL), Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China; and Cardiology Division, Department of Medicine (PC), Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.

ABSTRACT
Giant coronary artery aneurysm with a fistula is a rare condition. The presence of a giant aneurysm imposes considerable health risks. We report a case of a 67-year-old woman who presented with frequent ventricular premature contractions caused by a giant coronary aneurysm arising from a branch of the left anterior descending coronary artery that had a fistulous connection to the pulmonary artery. The patient was referred for cardiac surgery. The giant aneurysm was resected, and the proximal and distal openings were closed directly. The main pulmonary artery was opened longitudinally and the fistula was also closed directly. The patient's symptoms of frequent ventricular premature contractions disappeared postoperatively as confirmed by electrocardiography. Although the standard therapeutic strategies of the disease are not well established because of the rarity of this condition, our clinical results indicate that the surgical treatment is an effective choice.

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Related in: MedlinePlus

Preoperative cardiac images. A and B. Two-dimensional transthoracic and transesophageal echocardiography. A large cystic mass containing smoke-like echoes was observed adjacent to the ectatic left anterior descending artery. Blood flow into the pulmonary artery could be observed as color Doppler signals (yellow arrow: coronary artery aneurysm, white arrow: coronary artery fistula, green arrow: pulmonary artery) C. Axial section of CT image. Coronary artery aneurysm (dimensions 32 × 33 mm) with heterogenic contrast enhancement is seen (yellow arrow). D. Three-dimensional heart reconstruction of CT images. A giant coronary artery aneurysm was present at the branch artery of the left anterior descending artery (LAD), and the proximal portion of LAD was dilated and tortuous (yellow arrow: coronary artery aneurysm, green arrow: pulmonary artery). E. Coronary angiography. Left coronary artery angiography demonstrated a giant coronary aneurysm originating from branch of LAD with a fistulous connection to the pulmonary artery (yellow arrow). Postoperative cardiac images. F. Coronary angiography. The coronary artery aneurysm and coronary artery fistula disappeared (yellow arrow). Electrocardiography: G. Preoperative electrocardiography revealed frequent ventricular premature contractions. H. Postoperative electrocardiography revealed no frequent ventricular premature contractions.
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Figure 1: Preoperative cardiac images. A and B. Two-dimensional transthoracic and transesophageal echocardiography. A large cystic mass containing smoke-like echoes was observed adjacent to the ectatic left anterior descending artery. Blood flow into the pulmonary artery could be observed as color Doppler signals (yellow arrow: coronary artery aneurysm, white arrow: coronary artery fistula, green arrow: pulmonary artery) C. Axial section of CT image. Coronary artery aneurysm (dimensions 32 × 33 mm) with heterogenic contrast enhancement is seen (yellow arrow). D. Three-dimensional heart reconstruction of CT images. A giant coronary artery aneurysm was present at the branch artery of the left anterior descending artery (LAD), and the proximal portion of LAD was dilated and tortuous (yellow arrow: coronary artery aneurysm, green arrow: pulmonary artery). E. Coronary angiography. Left coronary artery angiography demonstrated a giant coronary aneurysm originating from branch of LAD with a fistulous connection to the pulmonary artery (yellow arrow). Postoperative cardiac images. F. Coronary angiography. The coronary artery aneurysm and coronary artery fistula disappeared (yellow arrow). Electrocardiography: G. Preoperative electrocardiography revealed frequent ventricular premature contractions. H. Postoperative electrocardiography revealed no frequent ventricular premature contractions.

Mentions: A 67-year-old woman was referred to our hospital due to frequent ventricular premature contractions for 2 months. Her medical history was unremarkable from the cardiologic point of view. Initial vital signs showed a body temperature of 36.8°C, blood pressure of 142/83 mm Hg, respiration rate of 18/min, and heart rate of 85 beats/min. A continuous Levine grade 2/6 cardiac murmur was heard at the second intercostal space at the right sternal border. Chest x-ray was normal and electrocardiography revealed frequent ventricular premature contractions. Laboratory studies showed a white blood cell count of 6.9 × 109/L, hemoglobin level of 137 g/L, platelet count of 225 × 109/L, C-reactive protein concentration of <1 mg/L, and the serum N-terminal pro-B-type natriuretic peptide level was 302.20 ng/L. Arterial blood gas analysis evaluated under room air showed partial pressures of oxygen and carbon dioxide of 89.1 mm Hg and 35.8 mm Hg, respectively. The transthoracic and transesophageal echocardiography showed a large cystic mass containing smoke-like echoes adjacent to the ectatic left anterior descending artery. Blood flow into the pulmonary artery (PA) could be observed as color Doppler signals (Figure 1A and B). Axial section of the computed tomography scan showed a CAA with the dimensions of 32 × 33 mm (Figure 1C). Three-dimensional reconstruction of the multislice CT scan images showed a giant coronary aneurysm located near the proximate-portion of the LAD, and the CAF was dilated and tortuous and connected with the PA (Figure 1D). Coronary angiography showed a giant aneurysm originating from a branch of the LAD, which had a fistulous connection to the PA (Figure 1E). Electrocardiogram showed sinus rhythm with frequent ventricular premature contractions (Figure 1G).


Giant coronary artery aneurysm with fistula to the pulmonary artery complicated by frequent ventricular premature contractions: a case report.

Cao H, Ye L, Chan P, Fan H, Liu Z - Medicine (Baltimore) (2015)

Preoperative cardiac images. A and B. Two-dimensional transthoracic and transesophageal echocardiography. A large cystic mass containing smoke-like echoes was observed adjacent to the ectatic left anterior descending artery. Blood flow into the pulmonary artery could be observed as color Doppler signals (yellow arrow: coronary artery aneurysm, white arrow: coronary artery fistula, green arrow: pulmonary artery) C. Axial section of CT image. Coronary artery aneurysm (dimensions 32 × 33 mm) with heterogenic contrast enhancement is seen (yellow arrow). D. Three-dimensional heart reconstruction of CT images. A giant coronary artery aneurysm was present at the branch artery of the left anterior descending artery (LAD), and the proximal portion of LAD was dilated and tortuous (yellow arrow: coronary artery aneurysm, green arrow: pulmonary artery). E. Coronary angiography. Left coronary artery angiography demonstrated a giant coronary aneurysm originating from branch of LAD with a fistulous connection to the pulmonary artery (yellow arrow). Postoperative cardiac images. F. Coronary angiography. The coronary artery aneurysm and coronary artery fistula disappeared (yellow arrow). Electrocardiography: G. Preoperative electrocardiography revealed frequent ventricular premature contractions. H. Postoperative electrocardiography revealed no frequent ventricular premature contractions.
© Copyright Policy - open-access
Related In: Results  -  Collection

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Figure 1: Preoperative cardiac images. A and B. Two-dimensional transthoracic and transesophageal echocardiography. A large cystic mass containing smoke-like echoes was observed adjacent to the ectatic left anterior descending artery. Blood flow into the pulmonary artery could be observed as color Doppler signals (yellow arrow: coronary artery aneurysm, white arrow: coronary artery fistula, green arrow: pulmonary artery) C. Axial section of CT image. Coronary artery aneurysm (dimensions 32 × 33 mm) with heterogenic contrast enhancement is seen (yellow arrow). D. Three-dimensional heart reconstruction of CT images. A giant coronary artery aneurysm was present at the branch artery of the left anterior descending artery (LAD), and the proximal portion of LAD was dilated and tortuous (yellow arrow: coronary artery aneurysm, green arrow: pulmonary artery). E. Coronary angiography. Left coronary artery angiography demonstrated a giant coronary aneurysm originating from branch of LAD with a fistulous connection to the pulmonary artery (yellow arrow). Postoperative cardiac images. F. Coronary angiography. The coronary artery aneurysm and coronary artery fistula disappeared (yellow arrow). Electrocardiography: G. Preoperative electrocardiography revealed frequent ventricular premature contractions. H. Postoperative electrocardiography revealed no frequent ventricular premature contractions.
Mentions: A 67-year-old woman was referred to our hospital due to frequent ventricular premature contractions for 2 months. Her medical history was unremarkable from the cardiologic point of view. Initial vital signs showed a body temperature of 36.8°C, blood pressure of 142/83 mm Hg, respiration rate of 18/min, and heart rate of 85 beats/min. A continuous Levine grade 2/6 cardiac murmur was heard at the second intercostal space at the right sternal border. Chest x-ray was normal and electrocardiography revealed frequent ventricular premature contractions. Laboratory studies showed a white blood cell count of 6.9 × 109/L, hemoglobin level of 137 g/L, platelet count of 225 × 109/L, C-reactive protein concentration of <1 mg/L, and the serum N-terminal pro-B-type natriuretic peptide level was 302.20 ng/L. Arterial blood gas analysis evaluated under room air showed partial pressures of oxygen and carbon dioxide of 89.1 mm Hg and 35.8 mm Hg, respectively. The transthoracic and transesophageal echocardiography showed a large cystic mass containing smoke-like echoes adjacent to the ectatic left anterior descending artery. Blood flow into the pulmonary artery (PA) could be observed as color Doppler signals (Figure 1A and B). Axial section of the computed tomography scan showed a CAA with the dimensions of 32 × 33 mm (Figure 1C). Three-dimensional reconstruction of the multislice CT scan images showed a giant coronary aneurysm located near the proximate-portion of the LAD, and the CAF was dilated and tortuous and connected with the PA (Figure 1D). Coronary angiography showed a giant aneurysm originating from a branch of the LAD, which had a fistulous connection to the PA (Figure 1E). Electrocardiogram showed sinus rhythm with frequent ventricular premature contractions (Figure 1G).

Bottom Line: The main pulmonary artery was opened longitudinally and the fistula was also closed directly.The patient's symptoms of frequent ventricular premature contractions disappeared postoperatively as confirmed by electrocardiography.Although the standard therapeutic strategies of the disease are not well established because of the rarity of this condition, our clinical results indicate that the surgical treatment is an effective choice.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiovascular Surgery (HC, LY, HF, ZL), Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China; and Cardiology Division, Department of Medicine (PC), Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.

ABSTRACT
Giant coronary artery aneurysm with a fistula is a rare condition. The presence of a giant aneurysm imposes considerable health risks. We report a case of a 67-year-old woman who presented with frequent ventricular premature contractions caused by a giant coronary aneurysm arising from a branch of the left anterior descending coronary artery that had a fistulous connection to the pulmonary artery. The patient was referred for cardiac surgery. The giant aneurysm was resected, and the proximal and distal openings were closed directly. The main pulmonary artery was opened longitudinally and the fistula was also closed directly. The patient's symptoms of frequent ventricular premature contractions disappeared postoperatively as confirmed by electrocardiography. Although the standard therapeutic strategies of the disease are not well established because of the rarity of this condition, our clinical results indicate that the surgical treatment is an effective choice.

Show MeSH
Related in: MedlinePlus