Coronary artery aneurysm

Source: Wikipedia, the free encyclopedia.
Coronary artery aneurysm
coronary angiography
Treatmentmedical management, surgical excision, coronary bypass grafting (CABG), and percutaneous coronary interventions[1]

Coronary artery

coronary angiography.[2]

Signs and symptoms

The majority of individuals suffering from coronary artery aneurysms do not exhibit any symptoms; the development of complications or concurrent atherosclerotic

coronary spasm, distal embolization, aneurysm rupture, local thrombosis, and compression of surrounding structures due to massive enlargement of coronary artery aneurysm.[3]

Causes

Acquired causes include

arterial wall, increased wall strain and slow dilatation of the coronary artery portion.[2]

It can also be congenital.[6][7] The following risk factors are thought to be associated with coronary artery aneurysms:

  1. Individual's genetic make-up, especially in patients with congenital coronary artery aneurysms
  2. Coronary artery disease (atherosclerosis)
  3. Vasculitic and connective tissue diseases (Kawasaki and Marfan)
  4. Intracoronary manipulation leading to local wall stress (stent placement, angioplasty, brachytherapy)
  5. Post-infectious as a consequence of direct wall infiltration or immune complex deposition[8]

Diagnosis

It is often found coincidentally on

computerized tomography. Although coronary angiography remains to be the gold standard, the invasive procedure comes with its associated risks, is more expensive than other modalities and the size of the aneurysm might be miscalculated if there is a thrombus in place.[2]

Treatment

Treatment for coronary artery aneurysm include medical management, surgery and percutaneous intervention. Underlying coronary artery risk factors should be addressed in patients with atherosclerosis and proper guideline-mediated medications should be started. In those with risk for embolism or thrombosis, anti-platelet or anticoagulation therapy should be contemplated.[2]

In patients with Kawasaki disease prompt administration of intravenous immunoglobulin (IVIG) therapy should be given to prevent complication of coronary artery aneurysm.[9]

Prognosis

Generally, it has a good prognosis.[3] In Kawasaki's disease, untreated, there is a 1–2% death rate, from cardiac causes.[citation needed]

The prognosis of coronary artery aneurysm is dependent on its diameter. The smaller the aneurysm the better the prognosis. There is less risk for ischemic myocardial damage and mortality with smaller aneurysms. Aneurysms with an internal diameter > 8 mm have poorer outcomes, since these aneurysms can be occluded and be associated with complications such as arrhythmias, myocardial infarction, or sudden death.[2]

See also

References

External links