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冠状动脉弥漫性扩张合并左前降支近端动脉瘤1例:病例报告

A rare case of diffuse ectasia in the coronary arteries and proximal aneurysm in the left anterior descending artery: A case report.

作者信息

Sohail Abdul Ahad, Wahab Rida, Rehman Haseeb Ur, Fatimi Asad, Fatimi Saulat Hasnain

机构信息

Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan.

Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan.

出版信息

Int J Surg Case Rep. 2023 Oct;111:108795. doi: 10.1016/j.ijscr.2023.108795. Epub 2023 Sep 6.

Abstract

INTRODUCTION

Coronary artery aneurysm is defined as dilatation of a segment of coronary artery, greater than 1.5 times the diameter of the largest normal coronary artery of the patient. Major cause of coronary artery aneurysm is coronary artery disease. Coronary artery aneurysm maybe an incidental finding during coronary angiography or it may present with symptoms including chest pain, myocardial infarction or even death.

CASE PRESENTATION

We present a rare case of a 59-year-old gentleman, who had, previously, underwent multiple left heart catheterizations and percutaneous coronary interventions. He presented to us with symptomatic diffuse ectasia of the coronary arteries with proximal aneurysm in the Left Anterior Descending Artery.

DISCUSSION

Coronary artery aneurysms are very rare with an incidence of about 0.02 %-0.04 % and a prevalence of 0.3 %-12 %. Right Coronary Artery is the principal site coronary artery aneurysms with a predominance of 83.8 %. The occurrence of multiple aneurysms is a very rare finding. About 73 % patients present with single aneurysms while only 27 % present with multiple aneurysms. Coronary artery aneurysms predispose to various complications including compression of the chambers, thrombosis and rupture.

CONCLUSION

From the presented case it can be concluded that even though, conservative management is available, surgical repair is the gold standard treatment, especially in the presence of multiple, symptomatic and large aneurysms in order to avoid fatal ischemic complications.

摘要

引言

冠状动脉瘤被定义为冠状动脉某一段的扩张,其直径大于患者最大正常冠状动脉直径的1.5倍。冠状动脉瘤的主要病因是冠状动脉疾病。冠状动脉瘤可能在冠状动脉造影时偶然发现,也可能表现出包括胸痛、心肌梗死甚至死亡等症状。

病例报告

我们报告一例罕见病例,患者为一名59岁男性,此前曾接受多次左心导管插入术和经皮冠状动脉介入治疗。他因有症状的冠状动脉弥漫性扩张并伴有左前降支近端动脉瘤前来就诊。

讨论

冠状动脉瘤非常罕见,发病率约为0.02% - 0.04%,患病率为0.3% - 12%。右冠状动脉是冠状动脉瘤的主要发生部位,占比83.8%。出现多个动脉瘤是非常罕见的情况。约73%的患者表现为单个动脉瘤,而只有27%的患者表现为多个动脉瘤。冠状动脉瘤易引发各种并发症,包括心腔受压、血栓形成和破裂。

结论

从该病例可以得出结论,尽管存在保守治疗方法,但手术修复是金标准治疗方法,尤其是在存在多个、有症状且较大的动脉瘤时,以避免致命的缺血性并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/212b/10507129/d5c6825a49f5/gr1.jpg

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