1/31. Coronary ostial aneurysms after composite graft replacement.Coronary ostial aneurysms after composite graft replacement of the ascending aorta and aortic valve is a rare complication. We report two patients with marfan syndrome who developed coronary ostial aneurysms at the sites of the coronary anastomosis, presumably because of oversized windows made in the graft. They were successfully treated by redo composite graft replacement. To prevent this complication, it is important to consider that the hole made in the tube graft should not be larger than the diameter of the respective coronary ostium to avoid exposure of the diseased aortic wall to the circulating blood as much as possible, and that the suture used to anastomose the coronary buttons should pass through the rim of the ostium rather than through the aortic wall surrounding it.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
2/31. Endovascular repair of traumatic pseudoaneurysm by uncovered self-expandable stenting with or without transstent coiling of the aneurysm cavity.Various surgical options for internal carotid or subclavian artery pseudoaneurysm repair have been reported; however, in general they have resulted in poor outcomes with high morbidity and mortality rates. Recently, these open surgical procedures have been partly replaced by percutaneous transluminal placement of endovascular devices. We evaluated the potential for using flexible self-expanding uncovered stents with or without coiling to treat extracranial internal carotid, subclavian and other peripheral artery posttraumatic pseudoaneurysm. Three patients with posttraumatic pseudoaneurysm were treated by stent deployment and coiling (two cases) of the aneurysm cavity. In one case, a 5.0 x 47 mm Wallstent (boston Scientific) was positioned to span the neck of the 9 x 5 mm size pseudoaneurysm (left internal carotid artery) and deployed. Angiography demonstrated complete occlusion of the pseudoaneurysm without coiling. In the second patient, a 5.0 x 31 mm Wallstent (boston Scientific) was positioned to span the neck of the 9 x 7 mm size pseudoaneurysm (right internal carotid artery) and deployed. A total of six coils (Guglielmi Detachable Coils, boston Scientific) were deployed into the pseudoaneurysm cavity until it was completely obliterated. In the third case, an 8.0 x 80 mm SMART (Cordis) stent was advanced over the wire, positioned to span the neck of the 10 x 7 mm size pseudoaneurysm of the left subclavian artery, and deployed. Fourteen 40 x 0.5 mm Trufill (Cordis) pushable coils were deployed into the pseudoaneurysm cavity until it was completely obliterated. At long-term follow-up (6-9 months), all patients were asymptomatic without flow into the aneurysm cavity by Duplex ultrasound. We conclude that uncovered endovascular flexible self-expanding stent placement with transstent coil embolization of the pseudoaneurysm cavity is a promising new technique to treat posttraumatic pseudoaneurysm vascular disease by minimally invasive methods, while preserving the patency of the vessel and side branches.- - - - - - - - - - ranking = 3keywords = size (Clic here for more details about this article) |
3/31. Giant coronary artery aneurysm arising from sinus node artery.A giant coronary aneurysm arising from the sinus node artery is reported. diagnosis of this lesion by computed tomography and angiography is illustrated. The operative management is described. "Off-pump" aneurysmectomy was successfully performed. The role of occlusion test of the aneurysm inflow tract is emphasized.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
4/31. Successful surgical repair of a giant left main coronary artery aneurysm with arteriovenous fistula draining into a persistent left superior vena cava and coronary sinus: role of intraoperative transesophageal echocardiography.We report the case of a 74-year-old woman with a history of hypertension, hypercholesterolemia, and pacemaker who presented to the hospital with new onset new york Heart association class IV congestive heart failure. Transthoracic echocardiography revealed a markedly dilated right ventricle with normal right ventricular systolic function. There was moderate pulmonary hypertension with an estimated pulmonary artery systolic pressure of 60 mm Hg. Her echocardiogram 1 year earlier had demonstrated normal right ventricular size and systolic function, and no pulmonary hypertension. Additional transthoracic imaging with saline contrast study through a left peripheral vein demonstrated the presence of a dilated coronary sinus with a persistent left superior vena cava. color Doppler demonstrated turbulent flow within the coronary sinus with evidence of significant left-to-right shunting. cardiac catheterization revealed a massively dilated left main coronary artery aneurysm with an arteriovenous fistula into the left superior vena cava and coronary sinus. The calculated Qp/Qs was 2:1. The patient underwent 2 unsuccessful attempts at percutaneous intervention to occlude the arteriovenous fistula. She then underwent successful surgical closure of the coronary arteriovenous fistula. The important role of intraoperative transesophageal echocardiography in guiding this technically challenging surgical case is discussed.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
5/31. Stent implantation for coronary aneurysm with edge stenosis: angiographic and intravascular analysis.The incidence of coronary artery aneurysms is about 1 to 2%, with clinical course dependent on the size of the aneurysm. A case of moderate-size aneurysm in the proximal left anterior descending coronary artery with stenosis at both edges is presented. This was interrogated with intravascular ultrasound (IVUS), and based on the patient's presentation, a single stent, size-matched 1:1 to the proximal reference, was placed across the aneurysm and both lesions. Post-implantation IVUS demonstrated residual stenosis and minimal change in the neck size of the aneurysm. At 4 months, there was no thrombosis or in-stent restenosis, and the aneurysm was almost completely resolved.- - - - - - - - - - ranking = 4keywords = size (Clic here for more details about this article) |
6/31. Bilateral coronary arteriovenous fistulas with an oversize left coronary aneurysm.We experienced an interesting case of bilateral coronary arteriovenous fistulas with coronary aneurysms (50 mm in the left and 10 mm in the right) developed in a 66-year-old woman. The pathological findings of both left and right aneurysms were quite similar. Etiological and surgical considerations about coronary aneurysm based on this case are discussed.- - - - - - - - - - ranking = 4keywords = size (Clic here for more details about this article) |
7/31. Complete proximal occlusion of all three main coronary arteries complicated with a left main coronary aneurysm: a case report.A 68-year-old woman with recurrent chest pain was referred to our institution. coronary angiography showed 100% obstruction of the left main trunk, the proximal right coronary artery with good collaterals to the left anterior descending artery and left circumflex artery along the conus artery. Emergency surgical revascularization was undertaken with two saphenous vein grafts. The saphenous vein grafts were placed in the left anterior descending artery, obtuse marginal branch and the posterolateral and posterior descending coronary arteries with excellent flow. The postoperative course was uneventful and follow-up angiography was obtained 20 days after the surgery. coronary angiography demonstrated a saccular aneurysm (10 x 9 mm) originating at the distal segment of the left main coronary artery with 90% stenosis, and excellent patency of both saphenous vein grafts. Follow-up angiography was performed 1 and 3 years after the surgery. The size of the left main coronary aneurysm remained unchanged at both examinations. The patient did well with no further cardiac symptoms after 5 years.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
8/31. Stress/rest (99m)Tc-MIBI SPECT and 123I-BMIPP scintigraphy for indication of surgery with coronary artery to pulmonary artery fistula.A 45-year old man was admitted to our hospital with chest pain occurring suddenly upon exercise and disappearing with rest within several minutes. A continuous murmur was heard at the upper sternum border. Conventional electrocardiography showed no evidence of myocardial ischemia. coronary angiography and cardiac catheterization demonstrated a fistula originating from the left coronary artery to the pulmonary artery with an aneurysm 2 cm in size, and Qp/Qs 1.08. Treadmill exercise testing showed no ST-T change at the maximum heart rate of 160 beats/min. Stress/rest (99m)technetium-MIBI single-photon emission computed tomography (SPECT) and 123I-15-(p-iodo-phenyl)-3,R,S-methylpentadecanoic acid (BMIPP) scintigraphy were performed to evaluate myocardial ischemia and ischemia was identified at the perfusion area of the left anterior descending artery. From these results, the patient was diagnosed as having a coronary artery to pulmonary artery fistula with myocardial ischemia. Consequently, surgical treatment was chosen under cardiopulmonary bypass. The determination of a surgical indication using stress/rest (99m)Tc-MIBI SPECT and BMIPP scintigraphy is useful in cases showing normal TMT, such as this case.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
9/31. Successful nitinol stent implantation in a large coronary aneurysm: post-interventional patency assessment by magnetic resonance imaging.Nitinol stents are thought to exhibit reduced occurrence of artifacts and may be suitable for magnetic resonance imaging (MRI) evaluation of stent localization and in-stent patency even in coronary-sized stent grafts. A 54-year-old male patient presented with a large coronary post-stenotic aneurysm of the right coronary artery (RCA) beside significant stenoses of the left circumflex coronary artery (LCX) and the left anterior descending coronary artery (LAD) with aneurysm formation. After implantation of stent grafts to the LAD and LCX, two polymermembrane-covered nitinol stent grafts were placed into the RCA. A control MR examination 7 days following the RCA intervention showed successful occlusion of the former aneurysm, no post-interventional endoleak, and bright signal within the stent indicating stent patency. Thus, coronary MRI after nitinol stent implantation in coronary aneurysms is feasible for post-interventional early imaging control at least as far as the exclusion of possible endoleaks is concerned.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
10/31. Vascular Behcet's disease with coronary artery aneurysm.A 33-year-old man with a 4-year history of Behcet's disease was hospitalized with acute myocardial infarction. percutaneous coronary intervention (PCI) treated 99% stenosis of the right coronary artery but follow-up coronary arteriography clearly revealed a coronary artery aneurysm (CAA) at the lesion proximal to the PCI site and intravascular ultrasound confirmed that it was a true aneurysm. We speculated that Behcet's disease might be involved in coronary lesion, especially in CAA formation. We decided to increase the dose of prednisolone and to add warfarin. The size of the CAA was not altered after 6 months.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
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