Coronary Artery Aneurysm: A Case Report
Amy Deckinga, M.D.
The Department of Anesthesiology
University of Florida College of Medicine
Aneurysmal dilation of the coronary arteries is a rare
occurrence. When it does happen, the most common cause is
atherosclerosis. Of the coronary vessels, the least frequently
involved is the left main coronary artery (LMA). A case is
presented of LMA aneurysm associated with severe atherosclerotic
coronary disease.
V.B. is a 51 year old male with a history of coronary artery
disease and a previous myocardial infarction in 1994. He had
stable angina from 1994 until 1999, when he began having
increasing frequency of angina. He underwent an exercise
treadmill test that elicited angina and ST depression. He then
had an adenosine thallium study that showed inferolateral
infarct and anterolateral ischemia. He was admitted for cardiac
catheterization.
The rest of his past medical history includes type 2 diabetes
mellitus, hypertension, hypercholesterolemia, schizophrenia,
post-traumatic stress disorder, and a gun shot wound to the
right ankle which subsequently became infected and resulted in a
right above knee amputation. He has no history of drug allergies
and his medications include aspirin, metoprolol, glyburide,
simvastatin, and isordil. He has a sixty pack-year smoking
history and quit in 1994. Family history is positive for
coronary artery disease. On physical examination, his blood
pressure was 117/77 mmHg, pulse was 70 beats per minute,
auscultation revealed clear lung fields and normal heart sounds.
Electrocardiogram showed sinus rhythm at a rate of 67 and q
waves in the inferior leads.
Cardiac catheterization revealed an aneurysm of the LMA
measuring 2.5cm x 2cm. In addition, he had diffuse three vessel
disease including 95% osteal left anterior descending, 100%
proximal circumflex, and 90% mid and distal right coronary
artery obstructions. At the time of cardiac catheterization an
intra-aortic balloon pump was placed and he was started on a
heparin drip. The cardio-thoracic surgery service was consulted
and he was scheduled for operative intervention the following
day.
At operation he underwent four vessel coronary artery bypass
grafting and ligation of the LMA. The aneurysm was visualized on
trans-esophageal echocardiogram performed prior to incision.
Aortic cross-clamp time was 79 minutes with a total
cardio-pulmonary bypass (CPB) time of 140 minutes, and moderate
hypothermia to 28 degrees. After re-warming, successful
cardioversion to normal sinus rhythm was performed. He was
weaned off of CPB and remained hemodynamically stable.
Post-operatively he was transferred to the cardio-thoracic
intensive care unit. He had an uneventful recovery and was
discharged home in stable condition.
In summary, this case represents a LMA aneurysm in association
with severe atherosclerotic heart disease. The patient underwent
successful 4 vessel bypass grafting and ligation of the LMA.
References:
1) Angiology 1999;50:417-20 3) Am Heart J 1992;123:222-24
2) Am J of Cardiol 1999;83:1290-93 4) J of Cardiovasc Surg
1994;35:311-314
