Giant left anterior descending coronary artery aneurysm

Small atherosclerotic coronary artery aneurysms are a relatively frequent incidental finding at angiography. We report an unusual case in that the aneurysm found was extremely large and therefore potentially at risk of rupture.     

Isolated aneurysm of the anterior descending coronary artery Surgical treatment

The case of an asymptomatic 30 year old man with an aneurysm in the proximal portion of the anterior descending branch of the left coronary artery is presented. The aneurysm was discovered because of an abnormal cardiac silhouette on a chest roentgenogram. Coronary angiograms demonstrated a localized fusiform aneurysm without shunt or fistula. After excision of the aneurysm, continuity of the artery was reestablished with a free saphenous vein graft. An associated anteroseptal myocardial infarction at the time of operation was an anticipated complication. Repeat coronary angiograms demonstrated patency of the graft and good distal flow 3 months postoperatively.     

Giant left atrial appendage aneurysm compressing the left anterior descending coronary artery

Left atrial appendage aneurysm (LAAA) is a rare congenital structural heart disease. It is often diagnosed by echocardiography; however, other imaging modalities can add to its diagnosis and its potential effects on the surrounding structures. A 16‐year‐old boy presented with dyspnea and palpitation. Transthoracic echocardiography showed a large LAAA communicating with the LA through a narrow neck with impaired left ventricular (LV) systolic function. Multidetector cardiac tomography showed that the LAAA is compressing the left anterior descending artery. The LAAA was surgically resected followed by improvement of the LV systolic function.     

Giant aneurysm of left anterior descending coronary artery treated by surgical off-pump therapy

Coronary artery aneurysms may predispose to acute thrombosis, embolisation and myocardial ischaemia or rupture with subsequent tamponade and/or sudden death. The optimal therapy for patients with coronary artery aneurysm is unknown, and controversy persists regarding the use of medical or surgical modalities. There is no doubt that surgical therapy is reserved for cases with large aneurysms or with myocardial ischaemia due to significant associated coronary artery stenoses. We discuss here the surgical management of a case with coronary artery aneurysm and concomitant coronary artery disease. Although the beating heart technique of myocardial revascularisation and repair of coronary artery aneurysm without cardiopulmonary bypass is not suitable for all patients, it should be considered for those high-risk patients who have impaired left ventricular function or who are at high risk for pulmonary or neurological complications.     

A previously undescribed anomaly of left anterior descending artery: type V dual left anterior descending artery

Dual left anterior descending coronary artery (LAD) is a group of rare congenital coronary artery anomalies and exhibits 4 different types. The goal of this article is to define a new, previously undescribed type of dual LAD anomaly.     

Bifurcating aneurysm of the left main coronary artery involving left anterior descending and left circumflex arteries--a case report.

Coronary artery aneurysm is a rare coronary abnormality, usually diagnosed incidentally by coronary angiography. Major causes of coronary aneurysms include coronary ectasia, Kawasaki disease, and atherosclerosis. Most of the discrete coronary aneurysms are of atherosclerotic origin. The incidence of atherosclerotic coronary aneurysms is about 0.2%, and the left main coronary artery is the least frequently involved artery. Only a few cases of left main coronary artery aneurysm have been reported in the literature, and a left main coronary artery aneurysm involving the proximal segments of the left anterior descending and the left circumflex arteries has not been reported previously. The authors describe this finding in a man who presented with worsening exertional angina pectoris. Coronary angiography demonstrated an aneurysm of the distal left main coronary artery extending into the proximal segments of the left anterior descending and the left circumflex arteries. In addition, a significant flow-limiting atherosclerotic lesion was present in the proximal portion of the left anterior descending artery distal to the aneurysm.     

前降支弥漫性病变冠心病的外科治疗

目的 :总结应用乳内动脉部分重建前降支治疗前降支弥漫性病变的冠心病的方法 ,以探讨该术式的治疗价值。方法 :2 6例病人中男 17例 ,女 19例 ;年龄 5 8～ 75岁 ,平均 6 3 2岁。有陈旧性心肌梗死史者 8例 ,3例有近期心肌梗死史 ,9例有不稳定心绞痛 ,均为三支血管病变 ,其中前降支为弥漫性病变。手术均在全身浅中度低温 ,中度血液稀释体外循环下施行。冷血心脏停跳液顺灌诱导、间断逆灌及终末温血灌注。前降支以左乳内动脉重建。前降支占重建后血管的 2 5 % ,而左乳内动脉占 75 %。结果 :无手术死亡。围术期心肌梗死 1例 ,占 1 2 6 (3 8% )。随访 1～ 6个月 ,1例术后心绞痛 ,再次造影示手术后降支吻合口血栓 ,其余病人无心脏事件发生。结论 :应用乳内动脉行弥漫性病变的前降支重建术是治疗前降支弥漫性病变冠心病的有效方法     

Isolated anomaly of the left anterior descending coronary artery

An isolated anomaly of the left anterior descending coronary artery arising from the right sinus of Valsalva is described. A review of the literature shows that isolated anomalies of this vessel are very rare. However, the inability to visualize this vessel from the left sinus of Valsalva warrants careful search of the right sinus.     

Surgical versus medical treatment of occlusive disease confined to the left anterior descending coronary artery

The results of saphenous vein bypass grafting and medical treatment were compared in 53 patients with stable angina pectoris, high grade occlusive disease confined to the left anterior descending coronary artery and normal or minimally impaired left ventricular function. Survival, incidence of myocardial infarction, relief of angina and response to exercise testing were evaluated. In the 29 surgically treated patients, followed up a mean of 24 months, there were two late deaths (7 percent) and five myocardial infarctions (17 percent). Twelve patients (41 percent) were free of angina and the majority had increased exercise performance when tested up to 18 months postoperatively. In the 24 medically treated patients, there were no deaths and one myocardial infarction (4 percent) in a mean follow-up period of 37 months. Six patients (25 percent) were free of angina. Less improvement in exercise performance was observed than in the surgically treated group.

This subset of patients with isolated left anterior descending coronary artery disease has a favorable prognosis that is not enhanced by bypass grafting. Surgical treatment is more effective than medical treatment in relieving angina and improving exercise performance in the early years after coronary arteriography.