Fareh S, Tabib A, Julié C, Loire R
Service d'anatomie pathologique, hôpital cardiovasculaire et pneumologique Louis-Pradel, BP Lyon-Monchat.
Arch Mal Coeur Vaiss. 1997 Apr;90(4):431-8.
The aim of this study was describe the anatomical features of coronary aneurysms and assess their role in causing death. Twenty clinico-pathological cases were recensed prospectively out of 8,920 autopsies (0.22%). The average age at death was 68 +/- 20 years (14 men and 6 women). Death was due to a cardiac cause in 90% of cases. The aneurysms were located on a single coronary artery in 14 cases, on 2 coronary arteries in 3 cases, and on all three arteries in 3 cases with a mean maximum diameter of 15 +/- 4.5 mm. Aneurysms of the right coronary artery were the most common (p < 0.01) and the largest (16.7 +/- 3.8 mm; p = 0.12) and circumflex arteries (12 +/- 3.1 mm, p = 0.03). The diameter of the coronary aneurysm was greater in the more elderly patients (r = 0.51 ; p = 0.022). The coronary aneurysms were diffuse in 10 subjects and localised in the other 10 (mainly fusiform and proximal). Only 3 aneurysms were directly associated with significant stenosis of the same artery. The aetiology was atherosclerosis in 18 cases, with associated extra-cardiac disease in 14 cases; the other 2 cases were dystrophic. The underlying anatomical abnormality constantly found was variable degrees of atrophy and destruction of the musculo-elastic elements of the media, a source of dilation. In 80% of cases, thrombosis of the aneurysm was directly or indirectly responsible for death. Coronary artery aneurysms are a rare finding and are frequently complicated by fatal thrombosis. Coronary angiographic detection of this condition characterised by the large size and absence of stenosis of the artery should lead to prophylactic antithrombotic therapy.
本研究的目的是描述冠状动脉瘤的解剖特征并评估其在导致死亡中的作用。在8920例尸检中前瞻性地复查了20例临床病理病例（0.22%）。死亡时的平均年龄为68±20岁（14例男性和6例女性）。90%的病例死亡原因是心脏原因。14例动脉瘤位于单一冠状动脉，3例位于2支冠状动脉，3例位于所有三支动脉，平均最大直径为15±4.5mm。右冠状动脉动脉瘤最常见（p<0.01）且最大（16.7±3.8mm；p=0.12），其次是回旋支动脉（12±3.1mm，p=0.03）。冠状动脉瘤的直径在年龄较大的患者中更大（r=0.51；p=0.022）。10例患者的冠状动脉瘤为弥漫性，另外10例为局限性（主要为梭形且位于近端）。只有3个动脉瘤与同一动脉的明显狭窄直接相关。病因在18例中为动脉粥样硬化，其中14例伴有心脏外疾病；另外2例为营养不良性。持续发现的潜在解剖异常是中膜肌肉弹性成分不同程度的萎缩和破坏，这是扩张的一个原因。80%的病例中，动脉瘤血栓直接或间接导致死亡。冠状动脉瘤是一种罕见的发现，常并发致命性血栓形成。冠状动脉造影检测到这种以动脉粗大且无狭窄为特征的情况应导致预防性抗血栓治疗。
