Multisaccular aneurysm in a coronary vein graft

This report describes an unusual multisaccular vein graft aneurysm that developed in a patient who had undergone aortocoronary bypass with a saphenous vein graft. The aneurysm was a complication of an atherosclerotic lesion. This case supports the belief that aortocoronary vein grafts have an increased susceptibility to aneurysm formation.     

Coronary artery aneurysm associated with aneurysm of descending thoracic aorta: Case report

Coronary artery aneurysm is one of the rare abnormalities of cardiovascular system. Coronary artery aneurysm concomitant with abdominal, and ascending thoracic aortic aneurysm has been reported, but with descending thoracic aneurysm has not been reported. We are presenting a case of atherosclerotic left circumflex coronary artery aneurysm associated with aneurysm of descending thoracic aorta.     

Serial assessment of the development of inflammatory abdominal aortic aneurysm from ordinary atherosclerotic abdominal aortic aneurysm using multidetector-row computed tomographic angiography

Inflammatory abdominal aortic aneurysm (AAA) is an aortic aneurysm of unknown etiology characterized by a thickened aneurysmal wall, perianeurysmal and retroperitoneal fibrosis, and adhesions to adjacent organs. We encountered a case of inflammatory AAA, which developed from an ordinary atherosclerotic AAA over a period of 14 months, with a rapid increase of 48 mm in the maximum diameter of the aneurysm over 12 days. This report describes the evaluation of the serial change by 16-channel multidetector-row computed tomographic (MDCT) angiography.     

Abdominal aortic aneurysm and diastasis recti

Midline abdominal incisional hernias are common following open repair of abdominal aortic aneurysms. These may be caused by the weakness of connective tissue. This study sought to determine the prevalence of diastasis recti among unoperated Caucasian males with abdominal aortic aneurysm compared to a control group with atherosclerotic lower extremity peripheral arterial disease. Forty-two consecutive white males referred for evaluation of abdominal aortic aneurysm (n = 18) or peripheral arterial disease (n = 24) were examined by a single examiner at the Mayo Clinic. Both groups were similar in terms of age and smoking history, 2 major risk factors for both abdominal aortic aneurysm and peripheral arterial disease. Abdominal aortic aneurysm patients ranged in age from 59 to 89 (mean, 73.2) years. Seventeen of 18 (94.4%) had a history of smoking. Peripheral arterial disease patients ranged in age from 52 to 93 (mean, 70.8) years. Twenty-one of 24 (87.5%) had a history of smoking. Diastasis recti were present in 12 of 18 (66.7%) subjects with abdominal aortic aneurysm versus 4 of 24 (16.7%) subjects with peripheral arterial disease (P = .001, 2-tailed Fisher exact test). Diastasis recti are significantly more common in males with abdominal aortic aneurysm than peripheral arterial disease and may provide an important clue to screen for abdominal aortic aneurysm in those at risk.     

Dissecting aneurysm of the thoracic aorta presenting as right atrial obstruction

A patient with a dissecting thoracic aortic aneurysm presented with acute low output cardiac failure due to right atrial obstruction. Five years earlier she had had her aortic valve replaced because of aortic regurgitation. Obstruction of the superior vena cava and pulmonary artery has been reported elsewhere as a complication of compression by thoracic aortic dissecting aneurysm. This case was unusual in presenting as right atrial obstruction.     

Dissecting aneurysm of the thoracic aorta presenting as right atrial obstruction.

A patient with a dissecting thoracic aortic aneurysm presented with acute low output cardiac failure due to right atrial obstruction. Five years earlier she had had her aortic valve replaced because of aortic regurgitation. Obstruction of the superior vena cava and pulmonary artery has been reported elsewhere as a complication of compression by thoracic aortic dissecting aneurysm. This case was unusual in presenting as right atrial obstruction.     

Left ventricular apical aneurysm as a consequence of diffuse type congenital nonfamilial supravalvular aortic stenosis in a 30-year-old female

Congenital nonfamilial supravalvular aortic stenosis (SVAS) is relatively rare, its diffuse type being the least common. We present a 30-year-old woman with diffuse SVAS complicated with left ventricular apical aneurysm. We believe that subtle left ventricular myocardial ischemia or infarction and long-lasting severe pressure overload to the apical chamber caused LV apical aneurysm in our case. Acquired LV apical aneurysm secondary to supravalvular aortic stenosis, in the absence of atherosclerotic coronary artery disease and hypertrophic obstructive cardiomyopathy, has not been described before.     

Stenosis of the right pulmonary artery: a complication of acute dissecting aneurysm of the ascending aorta

Attention is called to the occurrence of severe obstruction of the right main pulmonary artery as a consequence of acute dissection of the ascending aorta. The pulmonary arterial obstruction appears to have resulted from compression of this artery by an adventitial hematoma which extended from the ascending aorta after medial rupture of the aortic dissecting aneurysm. This complication of acute dissecting aortic aneurysm has not been described previously.     

Giant unruptured aneurysm of the thoracic aorta--a case report.

An asymptomatic 88-year-old woman underwent a screening medical examination. The chest x-ray film showed a large mediastinal mass with calcification. Both chest computed tomography and nuclear magnetic resonance imaging revealed an unruptured aortic aneurysm, predominantly affecting the ascending aorta and the proximal part of the aortic arch. Its maximum diameter was 10.5 cm. An ascending aortic aneurysm more than 10 cm in diameter is very rare. She died of acute pulmonary embolism unrelated to the aneurysm, and autopsy indicated that the etiology of the aneurysm was atherosclerotic degeneration. Retrospectively, the natural progression of the aneurysm was able to be followed on a series of chest x-ray films obtained over 18 years.     

Visualization of mitral valve aneurysm by transesophageal echocardiography

This article describes the transesophageal echocardiographic findings in a patient with pathologically proven mitral valve aneurysm. This aneurysm probably occurred as a complication of aortic valve endocarditis. Transesophageal echocardiography showed a saccular structure attached to the left atrial side of the anterior mitral leaflet with systolic expansion and diastolic collapse, and its orifice was visualized with excellent resolution. Transesophageal echocardiography is a useful diagnostic tool for evaluation of mitral valve aneurysm.     

Magnetic-resonance tomography of an inflammatory aneurysm

An inflammatory aneurysm is defined as an abacterial special type of atherosclerotic aneurysm. The macroscopic characteristics are: a porcellaneous appearance, excessive thickening of the aortic wall, and perianeurysmal adhesions. Chronic inflammatory infiltrations, which are localized in the adventitia, can be found via microscopy. With computed tomography the thickening of the aneurysmal wall can be demonstrated best. The appearance of an inflammatory aneurysm in magnetic-resonance tomography is described in one patient.     

Mycotic aneurysm of the left ventricular free wall complicating aortic valve endocarditis

We report the case of a 34-year-old man with aortic valve infective endocarditis caused by methicillin-resistant Staphylococcus aureus, complicated by an aortic annular abscess. A 23-mm St. Jude HP aortic mechanical prosthesis was implanted. The pre-discharge echocardiogram revealed a mycotic aneurysm of the basal posteroinferior wall, confirmed by cardiac magnetic resonance imaging, and it was decided to reintervene. The aneurysm was closed with a patch and the mitral valve had to be replaced. Although a small leak from the aneurysm patch persisted on the pre-discharge transthoracic echocardiogram, there was no trace of the aneurysm at nine-month re-evaluation. This case illustrates a rare complication of aortic valve endocarditis and shows the evolution of the mycotic aneurysm after closure via a transmitral approach.     

Expanding arch aneurysm causing a "kink" in a Bentall graft and heart failure

Marfan syndrome is associated with a high incidence of aortic root aneurysm and life-threatening aortic dissection. With the successful use of surgical aortic root replacement, dissection-related mortality has been significantly reduced. We present the case of a patient with Marfan syndrome who presented with heart failure secondary to an unusual graft-related complication 14 years after a Bentall procedure. Investigations revealed a supra-aortic stenosis resulting from a kink in the Bentall graft caused by pressure from an expanding aortic arch aneurysm. The patient underwent surgery with improvement in his ejection fraction and heart failure symptoms.     

Fortuitous rupture of aortic aneurysm: A catastrophic event affording time for surgical cure

The rupture of an aortic aneurysm is generally a fatal event, but occasionally the rupture will occur into an adjacent vascular structure, thereby preventing exsanguination and affording temporary survival. Three cases are presented illustrating the fortuitous nature of the rupture of an aortic aneurysm into a vascular structure. The first patient had an atherosclerotic abdominal aortic aneurysm that ruptured into the inferior vena cava and was successfully repaired. The second case demonstrates the formation of a fistula from the aorta to the left pulmonary artery in a patient with a syphilitic thoracic aortic aneurysm. In the third patient a dissecting aneurysm of the aortic root that communicated with the right ventricle after coronary bypass surgery was successfully repaired. Rarely, aortic aneurysms will rupture fortuitously into vascular capacitance structures. These three cases emphasize the need for early accurate diagnosis and the institution of appropriate surgical measures.     

Respiratory insufficiency caused by an aneurysm with multiple vascular lesions

A 71-year-old woman, who presented tracheobronchial obstruction caused by a thoracic aortic aneurysm, was admitted to our institution. Although she had multiple cerebral infarctions, old myocardial infarction, bilateral iliofemoral atherosclerotic lesions with abdominal aortic aneurysm, and superior vena cava syndrome, aneurysmectomy was undertaken in order to rescue her from respiratory insufficiency. The operation successfully relieved her of exertional dyspnea and dysphagia.     

Aortic valve cusp aneurysm as a result of blood culture-negative infective endocarditis,interesting echocardiographic and surgical images

Compared to mitral valve aneurysms, aortic valve (AV) aneurysm is a more rare and serious complication of infective endocarditis (IE). Early surgical intervention and valve replacement are required in order to prevent further complications such as embolization and rupture of aneurysm. We described a case of severe aortic regurgitation (AR) as a result of an aortic valve aneurysm in a patient with history of end-stage renal disease (ESRD) in whom the hemodialysis catheter had not been changed for a year.     

Smoking, atherosclerosis and risk of abdominal aortic aneurysm

AIMS: The role of cardiovascular risk factors and atherosclerosisin the aetiology of abdominal aortic aneurysms is not well understood.The aim of this study was to determine the association betweenatherosclerosis and aortic aneurysm in the general populationand the extent to which cardiovascular risk factors might increasethe risk of aneurysm independently of an effect on atheroscleroticdisease. METHODS AND RESULTS: In the Edinburgh Artery Study, 1592 men and women aged 55–74years were followed prospectively over a period of 5 years.Forty subjects were identified as having an abdominal aorticaneurysm and, for each, five controls were randomly selected.Cases showed a higher prevalence of cardiovascular disease (P0·001)and had a lower ankle brachial pressure index (P0·01).Current and recent ex-cigarette smokers had an increased riskof aortic aneurysm compared with long time ex-smokers and neversmokers (odds ratio 3·08, 95% CI 1·53 to 6·21Adjustment for concurrent atherosclerotic disease reduced theodds ratio to 2·63 (95% CI 1·26 to 5·45).The risk of aortic aneurysm was not related to elevation indiastolic blood pressure or in serum cholesterol. CONCLUSIONS: These findings indicate that atherosclerotic disease is associatedwith risk of aortic aneurysm in the general population. In addition,cigarette smoking appears to have a direct effect on the riskof aortic aneurysm which is independent of atherosclerosis.     

Giant syphilitic aortic aneurysm: a case report and review of the literature

Thoracic aortic aneurysm formation is a known complication of late syphilis. Large aneurysms may cause symptoms via mass effect. When aneurysms compress the pulmonary artery, pulmonary arterial hypertension and right heart failure may result. We report the case of a 76-year-old man who presented with right heart failure secondary to an 11-cm syphilitic thoracic aortic aneurysm, and discuss the evolving epidemiology, complications, diagnosis and management of syphilitic aortitis.     

Saccular aneurysm of pulmonary autograft after the Ross procedure.

The Ross procedure, which includes removal of the malformed aortic valve and replacement of a pulmonary autograft in the aortic position, has increased the number of available treatment options. Recently, dilatation of the autograft pulmonary root after the Ross procedure has been reported as a complication. We report a patient with bicuspid aortic valve malformations and aortic annulus dilatation, who had a saccular-form, true-type, aneurysm in the pulmonary autograft seven months after the Ross procedure. These changes have not been described so far as complication. Pathologically, marked mucoid degeneration was noted in the tunica media of the aneurysm, as well as in the original aortic root. These findings may suggest similar pathological characteristics between the aorta and pulmonary arteries. Hence, the surgical risks accompanying vascular characteristics in patients with congenital aortic valve malformations should be considered.