Mariscalco Giovanni, Mantovani Vittorio, Ferrarese Sandro, Leva Cristian, Orrù Alessandro, Sala Andrea
Department of Surgical Sciences, Cardiac Surgery Division, Varese University Hospital, 21100 Varese, Italy.
Cardiovasc Pathol. 2006 Mar-Apr;15(2):100-4. doi: 10.1016/j.carpath.2005.11.005.
Coronary artery aneurysm (CAA) is a dilatation that exceeds 1.5 times the diameter of a normal adjacent coronary artery. Several studies suggest that pathogenetic mechanisms involved in this disease and in abdominal aortic aneurysm (AAA) are similar. Surgery for CAA is mandatory when the aneurysm is three to four times larger than the original vessel diameter. We reviewed our experience in the surgical treatment of this unusual disease and analyzed its association with AAA.
Between October 1993 and March 2005, 11 patients (9 men; mean age=66 years) underwent surgery for CAA. In all cases, coronary aneurysms were diagnosed as incidental findings in coronary angiographies. The coronary aneurysms were isolated and longitudinally incised: the proximal and distal openings were identified and sutured. The sacs were obliterated with running sutures. Myocardial protection was achieved by retrograde cardioplegia only. Coronary artery bypass grafting was performed distally to the excluded aneurysms in all patients.
One patient died of respiratory failure early after the operations; all other patients are alive, asymptomatic for angina, and free from repeated acute myocardial infarction after a median follow-up of 76 months (range=4-141 months). A total of six patients underwent surgical repair or endoprosthesis implantation because of AAAs.
Our operative techniques ensured durable results. We recommend screening for abdominal aneurysms in all affected patients because of the frequent association between CAA and AAA as a result of their similar pathogenetic mechanism.
冠状动脉瘤（CAA）是指冠状动脉局部管径扩张超过临近正常冠状动脉管径1.5倍。多项研究表明，CAA与腹主动脉瘤（AAA）的发病机制相似。当动脉瘤直径为原血管直径的三到四倍时，CAA手术治疗势在必行。我们回顾了对这种罕见疾病的手术治疗经验，并分析了其与AAA的相关性。
1993年10月至2005年3月期间，11例患者（9例男性；平均年龄66岁）接受了CAA手术。所有病例中，冠状动脉瘤均在冠状动脉造影时偶然发现。将冠状动脉瘤分离并纵向切开，明确近端和远端开口并缝合。用连续缝合线封闭瘤腔。仅通过逆行心脏停搏实现心肌保护。所有患者均在动脉瘤远端进行冠状动脉旁路移植术。
1例患者术后早期死于呼吸衰竭；所有其他患者均存活，无心绞痛症状，中位随访76个月（范围4 - 141个月）后未发生反复急性心肌梗死。共有6例患者因AAA接受了手术修复或内置假体植入。
我们的手术技术确保了持久的效果。由于CAA和AAA发病机制相似，二者关联频繁，我们建议对所有CAA患者进行腹主动脉瘤筛查。
