1/679. Coronary artery aneurysms in a young adult: a case of sudden death. A late sequelae of Kawasaki disease? The case concerns the sudden death of a 21-year-old male during a soccer game. The autopsy revealed large, calcified saccular aneurysms at the origins of both the left anterior descending and the right coronary arteries. Histologically, the wall of the aneurysms was thin and composed of an internal fibro-calcified layer and an external thin tunica media. There was no evidence of active inflammation. The autopsy findings and a detailed medical history support the diagnosis of a late fatal sequela of Kawasaki disease. ( info) |
2/679. Coronary stent deployment in a young adult with Kawasaki disease and recurrent myocardial infarction. A 19-year-old man developed a huge coronary aneurysm and stenosis in the right coronary artery as a sequela of Kawasaki disease (KD) that resulted in recurrent episodes of myocardial infarction. Coronary ischemic events were successfully prevented after balloon angioplasty followed by coronary stent implantation into the stenotic lesion. The stent deployment may have an advantage compared with balloon angioplasty and other new devices for the treatment for patients with KD showing stenotic lesions without dense calcification. ( info) |
| myocardial infarction (MI) following blunt chest trauma is rarely diagnosed because the ensuing cardiac pain is commonly attributed to contused myocardium or the traumatic injuries in the local chest wall. There are only scattered reports on the coronary pathology associated with MI secondary to blunt chest trauma. Because differentiation of the pathology is difficult but important, we report here three cases of acute anterior MI secondary to coronary dissection following blunt chest trauma. Coronary dissection was demonstrated by coronary angiography. Two of the patients had intimal tears at the proximal left anterior descending artery (LAD) with normal flow, and the other patient had nearly total occlusion of the LAD associated with filling defects probably caused by an intracoronary thrombus. All three patients received conservative treatment without major complications and remained free from angina or heart failure throughout a 5-year follow-up period. In order to exclude associated MI in cases of blunt chest trauma, electrocardiography is necessary, and coronary angiography may be indicated to demonstrate coronary arterial pathology. dissection of the coronary artery with subsequent thrombus formation is one of the possible pathophysiologic mechanisms of MI following blunt chest trauma. ( info) |
4/679. Pseudoaneurysm following successful excimer laser coronary angioplasty of a restenotic left internal mammary artery graft ostial lesion. Although significant left internal mammary artery graft ostial stenosis is extremely rare, the clinical importance can be profound. In this report we describe a case in which a restenotic left internal mammary artery graft ostial lesion was successfully opened with excimer laser coronary angioplasty. A resulting pseudoaneurysm spontaneously closed after conservative therapy. ( info) |
5/679. Healing of the intimal dissection of the internal thoracic artery graft. We report healing of the intimal dissection of an internal thoracic artery graft. Triple coronary artery bypass grafting was performed using left internal thoracic artery and saphenous vein grafts. One month after operation, the intimal dissection of the internal thoracic artery graft was clearly visible by coronary angiography; however, after 1 year of only medical treatment consisting of warfarin, ticlopidine, and nitrate, the intimal dissection was undetectable by coronary angiography. ( info) |
6/679. Operative therapy of coronary arterial aneurysm. In summary, a patient with multiple coronary aneurysms and operative therapy is described and 17 previously reported similar cases are reviewed. The proper type of operation for this condition is as yet unclear, but, nevertheless, the reported cases and our case with operative therapy have done well postoperatively despite a variety of procedures performed. ( info) |
7/679. Treatment of a coronary aneurysm with a new polytetrafluoethylene-coated stent: a case report. A 43-year-old man underwent implantation of a PTFE-covered stent to exclude an aneurysm in an aorto-coronary venous bypass graft. A successful aneurysm closure was achieved after high-pressure stent expansion and no intimal hyperplasia was observed within the PTFE-covered stent segment in the angiogram performed 9 months later. The technical characteristics and indications of this new coronary prosthesis are discussed based on the authors' recent experience in 63 patients. ( info) |
8/679. Spontaneous coronary artery dissection: favorable outcome illustrated by angiographic data. Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction. It typically occurs in young women receiving oral contraceptive therapy or during the peripartum period. In the case presented here, spontaneous complete healing at angiography and the favorable outcome may support the role of conservative treatment in such patients. ( info) |
9/679. Bifurcating aneurysm of the left main coronary artery involving left anterior descending and left circumflex arteries--a case report. Coronary artery aneurysm is a rare coronary abnormality, usually diagnosed incidentally by coronary angiography. Major causes of coronary aneurysms include coronary ectasia, Kawasaki disease, and atherosclerosis. Most of the discrete coronary aneurysms are of atherosclerotic origin. The incidence of atherosclerotic coronary aneurysms is about 0.2%, and the left main coronary artery is the least frequently involved artery. Only a few cases of left main coronary artery aneurysm have been reported in the literature, and a left main coronary artery aneurysm involving the proximal segments of the left anterior descending and the left circumflex arteries has not been reported previously. The authors describe this finding in a man who presented with worsening exertional angina pectoris. coronary angiography demonstrated an aneurysm of the distal left main coronary artery extending into the proximal segments of the left anterior descending and the left circumflex arteries. In addition, a significant flow-limiting atherosclerotic lesion was present in the proximal portion of the left anterior descending artery distal to the aneurysm. ( info) |
10/679. Obliteration of a coronary artery aneurysm with a PTFE-covered stent: endoluminal graft for coronary disease revisited. This is the first reported use of the JOSTENT stent graft for aneurysm disease in native coronaries. Consideration can be given to using this polytetrafluoroethylene (PTFE)-covered stent in situations such as dissections and restenosis in saphenous vein grafts or in long native coronary arteries without side branches, though further investigation is warranted. ( info) |