Gerardo Musuraca1*, Ferdinando Imperadore1, Clotilde Terraneo2 and Emiliano Boldi3
1Division of Cardiology, S. Maria del Carmine Hospital, Rovereto (TN), Italy
2Division of Cardiology, Policlinico Hospital, Monza (MI), Italy
3Division of Cardiology, S. Rocco di Franciacorta, Ome (BS), Italy
Received: 29 February, 2016;Accepted: 03 March, 2016; Published: 07 March, 2016
Gerardo Musuraca, Division of Cardiology, S. Maria del Carmine Hospital, Rovereto (TN), Italy, E-mail:
Musuraca G, Imperadore F, Terraneo C, Boldi E (2016) Atherosclerotic Monstrous Double Aneurysm of the Left Main Coronary Artery: A Very Rare Angiographic Finding. J Cardiovasc Med Cardiol 3(1): 012-013. DOI: 10.17352/2455-2976.000022
© 2016 Musuraca G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Coronary artery aneurysm is a rare disease diagnosed in 0.3 to 4.9% of patients undergoing coronary angiography. The incidence of left main coronary artery aneurysm (LMCAA) is extremely rare: 0.1% . Coronary artery aneurysm involves the right coronary artery, the left anterior descending and circumflex coronary arteries in descending order of frequency  and atherosclerosis is the most common cause. Other causes include arteritis, Kawasaki disease, angioplasty sequelae, laser procedures, traumatic injury, dissection, connective tissue disorders, Takayasu’s arteritis, congenital (anomaly or genetic disorders such as Ehler-Danlos syndrome, Marfan syndrome) mycotic and idiopathic diseases. Although surgery has been recommended to prevent complication, there are no large available data comparing medical and surgical therapy [3-5]. The LMCAA is a rare clinical entities, encountered incidentally in approximately 0.1% of patients undergone routine angiography [6,7]. The sizes of LMCAAs may be fusiform or saccular. Management of these cases is still controversial, based on anedoctal experience rather than controlled trials.
We present a case of a 68 year old man referred to our Institution because of ingravescent dyspnea and orthopnea. The angiographic study showed a left main large aneurism involving the ostia of the left anterior descending artery and circumflex artery. The patient was referred to Cardio chirurgic Center for by-pass surgery intervention.
A 68 year old man was referred to our Hospital because of worsening dyspnea and orthopnea. He had a past medical history of hypertension, dislipidemia and polivasculophaty. Laboratory data were normal. Physical examination showed bilateral pulmonary crackles. Electrocardiogram was normal without Q waves or ST-T segment changes. The patient was treated with conservative therapy: diuretics and inotropic agents ev. The situation evolved better rapidly.
Four days later a coronary angiography was performed and showed a large ectasia of the medium tract and a very large aneurysm (11.2 x 8.5 mm) originating at the distal segment of the left main coronary artery. The true aneurysm involved the ostia of the left anterior descending, the ramus intermedius and circumflex coronary artery (Figure 1 and Figure 2).
- Lenihan CD, Zeman MH, Collins MG (1991) Left main coronary artery aneurysm in association with severe atherosclerosis. A case report and review of the literature. Cathet Cardiovasc Diagn 23-31 .
- Syed M, Lesch M (1997) Coronary artery aneurysm: a review. Progr Cardiovasc Dis 40: 77-84 .
- Kessler M, Hamby RI, Hilsenrath J (1980) Aneurism of the left main coronary artery. Br Heart J 44: 228-230 .
- Smith MD, Cowley Mj, Vetrovec GW (1984) Aneurysm of the left main coronary artery: a report of three cases and review of the literature. Cathet Cardiovasc Diagn 10: 583-591 .
- Newcomb EW, Youngman DJ, Burton NA (1984) Atherosclerotic aneurysm of the left main coronary artery. J Am Coll Cardiol 4: 1062-1064 .
- Bricker DL, Rittman DV Jr (1990) Arteriosclerotic aneurysm of the coronary arteries: surgical treatment. Texas Heart Inst J 14: 23-30.
- Hawkins JW, Vacek JL, Smith GS (1990) Massive aneurysm of the left main coronary artery. AM Heart J 119: 1406-1408 .
- Lazarus A, Donzeau-Gouge P, Spaulding C, Weber S, Guérin F (1992) Surgical treatment of an atherosclerotic aneurysm of the left main coronary artery. Am Heart J 123: 222-224 .
- Fukaya Y, Miyakawa M, Senga O, Hikita H, Kouzu S, et al. (1994) Surgical management of left main coronary artery aneurysm. Ann Thorac Surg 57: 228-230.
- Nogaki H, Shioi K, Mase T, Aoyama T, Miura A, et al. (1998) Two cases of coronary artery aneurysm including one case of the left main coronary artery aneurysm. Nippon Kyobu Geka Gakkai Zasshi 46: 513 .
- Lijoi A, Parodi E, Dottori V, Scarano F, Podestà A, et al. (2001) Atherosclerotic aneurysm of the left main caronary artery. Minerva Cardioangiol 49: 343-347 .
- Alioglu E, Turk UO, Engin C, Tengiz I, Tuzun N, et al. (2009) Left main coronary artery aneurysm in young patient with acute myocardial infarction. J Cardiovasc Med 10: 494-496 .
- Ormerod JO, Lim J, Chandrasekaran B, Ramcharitar S, Garg S, et al. (2016) How should I treat a patient with giant left main coronary artery aneurysm without associated stenosis? EuroIntervention 11: 1080-1082 .
- Zhang S, Liu G, Tielian Yu, Zhou G, Zheng R (2015) Giant right coronary artery aneurysm secondary to Kawasaki disease in child: a case report. Int J Clin Exp Pathol 8: 9468-9470 .
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