左主干至左旋支动脉巨大动脉瘤的保守治疗

Conservative Management of Giant Aneurysm of the Left Main to Left Circumflex Arteries.

作者信息

Boutaleb Amine Mamoun, Boulogne Cyrille, Chenard Pierre, Martins Elie, Boukhris Marouane, Cianci Andrea, Le Bivic Louis, Jouan Jérôme, Aboyans Victor

机构信息

Department of Cardiology, Dupuytren University Hospital, Limoges, France.

出版信息

JACC Case Rep. 2025 Sep 3;30(26):104881. doi: 10.1016/j.jaccas.2025.104881.

DOI:10.1016/j.jaccas.2025.104881

PMID:40912847

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12426666/

Abstract

BACKGROUND

Coronary artery aneurysm (CAA) is a rare congenital or acquired coronary malformation, associated with coronary artery fistula (CAF) in approximately 15% of cases. CAA is often asymptomatic.

CASE SUMMARY

We report the case of a 60-year-old woman diagnosed in 2017 with a 15-mm large giant left main to left circumflex CAA. In 2024, she presented with progressive dyspnea. Multimodality imaging revealed severe mitral valve regurgitation and giant CAA associated with a distal CAF. After comprehensive evaluation, the heart team opted for mitral valve surgery and conservative CAA management. After 9-month follow-up, she remains uneventful.

DISCUSSION

Management of giant CAA is controversial. Surgery remains the gold standard treatment, yet particularly challenging. It is mainly recommended for symptomatic patients, with evidence of ischemia or a significant left-to-right shunt.

TAKE-HOME MESSAGES: Conservative therapy remains a valuable option in asymptomatic cases, provided that close follow-up is ensured. Multimodal imaging is crucial for diagnosis, management, and surveillance.

摘要