coronary Aneurysms closest differential diagnosis is ectasia

1. CORONARY ANEURYSMS

2. Intr0duction
 Aneurysmal coronary artery disease is seen in 0.3-5% of patients
undergoing CAG, Giant aneurysms having a prevalence of 0.02% -
2.0%
 Localised luminal dilation measuring atleast 1.3-2 times the
diameter of a normal, adjacent reference segment.
 Giant Anuerysms – no universal definition - >20mm,40 mm 0r
four times the reference vessel diameter have all been proposed as
definitive giant aneurysms in literature.
Cohen P, O’Gara PT. Coronary artery aneurysms: a review of the natural history, pathophysiology, and management.
Cardiol Rev 2008;16(6):301-4.
Nichols L, Lagana S, Parwani A. Coronary artery aneurysm: a review and hypothesis regarding etiology.
Arch Pathol Lab Med 2008;132(5):823-8.
Morita H, Ozawa H, Yamazaki S, Yamauchi Y, Tsuji M, Katsumata T, Ishizaka N. A case of giant coronary artery aneurysm with fistulous
connection to the pulmonary artery: a case report and review of the literature. Intern Med 2012;51 (11):1361-6.
Keyser et al (2012) - A compilation of 28 cases of >50 mm over a period of 49 years

3. Etiology
 Atherosclerosis (most common cause )
 Takayasu arteritis
 Kawasaki disease
 Ehler Danlos syndrome,Marfan syndrome,Polyarteritis Nodosa
 Fibromuscular dysplasia
 SLE,Behcet’s disease
 Trauma
 Syphilitic aortitis
 Congenital
 Secondary to Percutaneous interventions – angioplasty, atherectomy,
stenting
Cohen P, O’Gara PT. Coronary artery aneurysms: a review of the natural history, pathophysiology, and
management. Cardiol Rev 2008;16(6):301-4.

4. Pathogenesis
 Disruption of the intima and media on the histology.
Inherent defect in the vessel wall can predispose atherosclerosis
to aneurysm formation.
Media is weakened in areas of marked atherosclerosis with
decrease in elasticity – decreased stress intolerance to the
intraluminal pressure – dilation of the vessel.
Delayed reendothelization
Hypersensitivity reactions
Residual non healing dissections
High pressure balloon inflations
Percutaneous interventions
Chrissoheris MP, Donohue TJ, Young RS, Ghantous A. Coronary artery aneurysms. Cardiol Rev 2008;16(3):116-23.
Kelley MP, Carver JR. Coronary artery aneurysms. J Invasive Cardiol 2002;14(8):461-2.

6. Natural History
 Usually Asymptomatic
 Presentation can be with angina, sudden death, tamponade,
congestive heart failure.
 Rarely as SVC syndrome, mediastinal mass
 Sequelae – thrombus formation, embolization, fistula formation,
rupture.
 Can produce mid-diastolic murmur in 3rd left ICS
 Approx. 25% of patients with a giant CAA will have an
associated coronary fistula. (Moritia et al,2011)
Cohen P, Coronary artery aneurysms: a review of the natural history, pathophysiology, and management. Cardiol Rev 2008;16(6):301-4.
Falsetti HL, Coronary artery aneurysm. A review of the literature with a report of 11 new cases. Chest 1976;69 (5):630-6.
Mata KM, Coronary artery aneurysms: an update. In:Lakshmanadoss U, editor. Novel strategies in ischemic heart disease. InTech; 2012. p. 381-40
Zoneraich S, Giant coronary artery aneurysm. The cause of middiastolic murmur and bulging of the left cardiac border. JAMA 1975;231(2):179.

7. Management
 Surgical correction is the preferred treatment.
 Aneurysmal ligation with distal bypass grafting
 Isolated coronary artery bypass grafting
 Anuerysm plication
 Saphenous venin patch repair of the aneurysm.
 Antiplatelet or anticoagulants or both – to decrease the risk
of thrombus and embolization.
 PTFE covered stents
 > 10 mm size aneurysms –high restenosis.
Cohen P, Coronary artery aneurysms: a review of the natural history, pathophysiology, and management.
Cardiol Rev 2008;16(6):301-4.
Chrissoheris MP, Coronary artery aneurysms. Cardiol Rev 2008;16(3):116-23.
Szalat A, Use of polytetrafluoroethylene- covered stent for treatment of coronary artery aneurysm. Catheter
Cardiovasc Interv 2005;66(2):203-8.