Circulation. 2000;101:e202-e204
(Circulation. 2000;101:e202.)
© 2000 American Heart Association, Inc.
Circulation Electronic Pages |
Three-Dimensional Densimetric Analysis of Coronary Artery Aneurysm
Michael Poullis, MBBS, FRCS(Eng)
From the Department of Cardiothoracic Surgery, National Heart and Lung
Institute, Imperial College of Science, Technology, and Medicine, Hammersmith
Hospital, London, UK.
Correspondence to Dr Michael Poullis, Cardiothoracic Research Fellow, Department of Cardiothoracic Surgery, Hammersmith Hospital, Du Cane Rd, E Acton, London, W12 0NN, UK. E-mail mpoullis{at}rpms.ac.uk
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Introduction
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 Top
 Introduction
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A 43-year-old man,
previously fit and well, was admitted with
an anterior myocardial
infarct treated with recombinant tissue
plasminogen
activator. Five days later, he underwent coronary
angiography,
which demonstrated a proximal aneurysm of the left
anterior
descending coronary artery (LAD) (Figure 1
), with a severe stenosis
immediately
distal to the aneurysm (Figure 2
) and right coronary artery
disease
(Figure 3
).
The presence of a clot or atherosclerotic plaque in the
aneurysm sac, which might be disrupted and cause distal
embolization with occlusion of the LAD at the site of the
stenosis, could be excluded via quantitative 3D angiography of
the aneurysm sac. Figure 4 shows
the saccular/eccentric nature of the aneurysm sac, and Figure 5 demonstrates the absence of a clot or
atherosclerotic plaque within the aneurysm. Figure 6 demonstrates a 3D reconstruction of the
disease in the right coronary artery. Unfortunately, attempted
angioplasty of the stenosis resulted in the coiling of the
guidewire in the aneurysm sac (Figure 7). The patient was referred for
coronary artery surgery. He made an uneventful recovery and was
discharged 6 days later.
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Figure 4. Quantitative 3D angiography demonstrating
eccentric nature of aneurysm. LAD is clearly seen entering and
leaving eccentric/saccular aneurysm sac. Appearance of
aneurysm as a "hole" indicates that no clot or
atherosclerotic plaque is present in sac. Clot or plaque would
cause angiographic contrast density change that might be too subtle to
be perceived by human eye unless excessive amount is present.
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Figure 5. Cross section through aneurysm
demonstrating no concealed plaque or hematoma within aneurysm
sac. In cross-sectional views, any clot or plaque would be seen as
protrusions from wall into "hole."
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Footnotes
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The editor of Images in Cardiovascular Medicine is Hugh A. McAllister,
Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal
Hospital and Texas Heart Institute, and Clinical Professor of
Pathology, University of Texas Medical School and Baylor College
of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
