Pota Panupong, Suwannasom Pannipa, Woragidpoonpol Surin, Srisuwan Tanop
Division of Cardiology, Department of Internal Medicine, Faculty of Internal Medicine, Chiang Mai University, 110 Intavaroros Road, Sripoom District, Muang, Chiang Mai 50200, Thailand.
Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand.
Eur Heart J Case Rep. 2021 Nov 8;5(11):ytab452. doi: 10.1093/ehjcr/ytab452. eCollection 2021 Nov.
IgG4-related disease (IgG4-RD) is a chronic fibroinflammatory condition with multiple-organ involvement. Rupture of coronary artery aneurysms (CAAs) in IgG4-RD is rare.
A 65-year-old man with IgG4-RD has suffered from recurrent episodes of arterial aneurysms since 2003. He presented with chest pain and hypotension caused by localized cardiac tamponade at right ventricle free wall due to the rupture of coronary artery aneurysm (CAA) of left anterior descending artery (LAD). An urgent LAD aneurysm repaired with bovine pericardium and obliterated aneurysmal sac with cryo-acrylate glue was done together with coronary artery bypass grafting (CABG) using saphenous vein graft (SVG) to LAD and SVG to posterior descending artery. Three-month after surgery, the follow-up coronary computed tomography angiography (CCTA) revealed a growing in size of LAD and the second obtuse marginal (OM) branch aneurysm. Heart team discussion agreed to schedule the patient for double coil embolization to LAD and second OM aneurysm under intravascular ultrasound guidance. Both aneurysms were successfully obliterated with vascular coils. Two-week follow-up coronary angiogram showed complete occlusion of LAD aneurysm and near occlusion of the second OM branch aneurysm.
Coronary artery aneurysm rupture is a life-threatening condition that required prompt detection and treatments. In IgG4-RD patients, acute cardiac tamponade suggesting the rupture of CAA. Coil embolization is an alternative treatment in patients who suffered from recurrent CAA after surgical repair. Serial CCTA is important for early detection of aneurysm in IgG4-RD patients who had vascular involvement.
IgG4相关性疾病（IgG4-RD）是一种累及多器官的慢性纤维炎症性疾病。IgG4-RD患者冠状动脉瘤（CAA）破裂较为罕见。
一名65岁的IgG4-RD男性患者自2003年以来反复出现动脉瘤发作。他因左前降支（LAD）冠状动脉瘤破裂导致右心室游离壁局限性心脏压塞，出现胸痛和低血压症状。紧急进行了LAD动脉瘤修复术，使用牛心包修复，并使用低温丙烯酸酯胶闭塞动脉瘤囊，同时使用大隐静脉移植物（SVG）对LAD和后降支进行冠状动脉旁路移植术（CABG）。术后3个月，随访冠状动脉计算机断层扫描血管造影（CCTA）显示LAD及第二钝缘支（OM）动脉瘤增大。心脏团队讨论后同意安排患者在血管内超声引导下对LAD及第二OM动脉瘤进行双线圈栓塞术。两个动脉瘤均成功使用血管线圈闭塞。术后2周冠状动脉造影显示LAD动脉瘤完全闭塞，第二OM支动脉瘤接近闭塞。
冠状动脉瘤破裂是一种危及生命的情况，需要及时发现和治疗。在IgG4-RD患者中，急性心脏压塞提示CAA破裂。对于手术修复后反复出现CAA的患者，线圈栓塞是一种替代治疗方法。对于有血管受累的IgG4-RD患者，连续CCTA对于早期发现动脉瘤很重要。
