PDF(Pubmed)
Abstract：
A 59-year-old woman, smoker, hypertensive, without a previous history of coronary artery disease referred several episodes of epigastric pain, after exercise electrocardiogram was referred to coronary angiography. It revealed extensive coronary calcification, with a suboccluded left anterior descending (LAD) and a calcified aneurysm of the right coronary artery (RCA), partially filled with thrombus. Coronary-computed tomography showed aneurysmal saccular dilatation of the proximal LAD entirely thrombosed with subocclusion, and a fusiform aneurysm in the proximal RCA, partially thrombosed. The patient was referred for surgical treatment. In our patient, congenital etiology of the aneurysms was unlikely, since the patient did not present congenital heart disease or known genetically inherited disorders. Among acquired aneurysms, the most common cause is represented by atherosclerosis. Other potential causes are connective tissue disorders, trauma, infections, iatrogenic, and Kawasaki syndrome. Usual complications include myocardial ischemia and infarction, embolism, rupture, fistulization, and thrombosis (clearly represented in our case). Current recommendations about management strategies of coronary artery aneurysms (CAAs) are focused on small case series and based on aneurysm\'s location and morphology, patient\'s characteristics, and clinical presentation. Medical treatment strategies include antiplatelet therapy or anticoagulant. Other therapeutical options are percutaneous coronary intervention (PCI) and coronary artery bypass graft. In our case, the heart team opted for surgical treatment due to the subocclusion of the proximal LAD and considering stable angina as admitting diagnosis. Moreover, the CAAs were placed in proximal segments, with a large amount of thrombus, so related with high risk for complications if PCI was performed.
摘要：
一个59岁的女人,吸烟者,高血压，以前没有冠状动脉疾病史的患者有几次上腹痛发作，运动后心电图参考冠状动脉造影。它显示了广泛的冠状动脉钙化，左前降支（LAD）和右冠状动脉钙化动脉瘤（RCA），部分充满血栓。冠状动脉计算机断层扫描显示，近端LAD的动脉瘤囊状扩张完全与亚闭塞血栓形成，和近端RCA的梭形动脉瘤，部分血栓形成。患者被转介接受手术治疗。在我们的病人身上，动脉瘤的先天性病因不太可能，因为患者没有出现先天性心脏病或已知的遗传性疾病。在获得性动脉瘤中，最常见的原因是动脉粥样硬化。其他潜在原因是结缔组织疾病，创伤,感染,医源性,和川崎综合征.常见的并发症包括心肌缺血和梗塞，栓塞,破裂,成虫,和血栓形成（在我们的案例中清楚地表现出来）。目前关于冠状动脉瘤(CAA)管理策略的建议主要集中在小病例系列和基于动脉瘤的位置和形态,患者的特征，和临床表现。医学治疗策略包括抗血小板治疗或抗凝血剂。其他治疗选择是经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术。在我们的案例中,心脏研究小组选择了手术治疗,原因是近端LAD未闭塞,并将稳定型心绞痛视为确诊.此外，CAA被放置在近端，有大量的血栓，因此，如果进行PCI，则与并发症的高风险有关。
