Befeler B, Aranda M J, Embi A, Mullin F L, El-Sherif N, Lazzara R
Am J Med. 1977 Apr;62(4):597-607. doi: 10.1016/0002-9343(77)90423-5.
Coronary artery aneurysms were found in 16 men between 37 and 62 years of age, mean 51 years. Aneurysms were of two types: saccular and fusiform. They involved the right coronary artery in 13 (87 per cent), the circumflex artery in eight (50 per cent) and the left anterior descending artery in five (31 per cent). In some patients, more than one vessel was involved. Twelve patients presented with angina pectoris, three with congestive heart failure and one with both. Five were in functional class II, eight were in class III and three were in class IV at the beginning of the study. The electrocardiogram showed evidence of previous myocardial infarction in four patients; four patients had left ventricular hypertrophy, one had left axis deviation, one had left bundle branch block, one had right bundle branch block, two had first degree atrioventricular block and seven had abnormalities in the S-T segment and T wave. Obstructive coronary disease was present in all; the obstruction score was from 1 to 4 in three patients, from 5 to 9 in four patients and from 10 to 14 in the remaining nine. Similar aneurysms were found in the pulmonary artery of one patient and in the abdominal aorta of three patients; in seven of 14 patients with adequate venous angiograms, varicosities of the coronary venous tree were observed. Left ventricular dysfunction and angina pectoris were noted in patients with significant obstructive coronary disease (greater than 70 per cent) and also in patients without obstruction but with coronary aneurysms. Ten patients were treated surgically; nine underwent aortocoronary bypass and one mitral valve replacement. Criteria for bypass was the presence of obstructive disease and medically unresponsive angina pectoris. All but one surgically treated patient showed improvement. The functional class in medically treated patients was unchanged. Fourteen patients were still alive at the completion of the study. The findings of this study suggest that angina pectoris and left ventricular dysfunction can occur with coronary artery aneurysm without coronary artery obstructions. Coronary aneurysms may be a subset of atherosclerosis, and this process may involve other vascular territories. The prognosis in those patients appears to be no worse than in patients with obstructive coronary disease and no aneurysms.
在16名年龄在37至62岁之间（平均51岁）的男性中发现了冠状动脉瘤。动脉瘤有两种类型：囊状和梭形。它们累及右冠状动脉13例（87%），回旋支动脉8例（50%），左前降支动脉5例（31%）。在一些患者中，不止一支血管受累。12例患者出现心绞痛，3例出现充血性心力衰竭，1例两者兼有。在研究开始时，5例为心功能Ⅱ级，8例为Ⅲ级，3例为Ⅳ级。心电图显示4例患者有既往心肌梗死的证据；4例患者有左心室肥厚，1例有左轴偏移，1例有左束支传导阻滞，1例有右束支传导阻滞，2例有一度房室传导阻滞，7例有ST段和T波异常。所有患者均存在阻塞性冠状动脉疾病；3例患者的阻塞评分为1至4分，4例患者为5至9分，其余9例患者为10至14分。在1例患者的肺动脉和3例患者的腹主动脉中发现了类似的动脉瘤；在14例有足够静脉血管造影的患者中，7例观察到冠状静脉树静脉曲张。在有严重阻塞性冠状动脉疾病（大于70%）的患者以及没有阻塞但有冠状动脉瘤的患者中均发现了左心室功能障碍和心绞痛。10例患者接受了手术治疗；9例接受了主动脉冠状动脉搭桥术，1例接受了二尖瓣置换术。搭桥的标准是存在阻塞性疾病且药物治疗无效的心绞痛。除1例手术治疗患者外，所有患者均有改善。药物治疗患者的心功能分级未改变。研究结束时，14例患者仍存活。本研究结果表明，在没有冠状动脉阻塞的情况下，冠状动脉瘤也可能出现心绞痛和左心室功能障碍。冠状动脉瘤可能是动脉粥样硬化的一个子集，并且这个过程可能累及其他血管区域。这些患者的预后似乎并不比有阻塞性冠状动脉疾病且无动脉瘤的患者更差。
