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(Circulation. 1999;100:E8-E11.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Percutaneous Transcatheter Management of Giant Coronary Aneurysms

Michael A. Peterson, MD; Lee H. Monsein, MD; George Dangas, MD; Roxana Mehran, MD; Martin B. Leon, MD

From the Cardiology Research Foundation and the Department of Radiology (L.H.M.), Washington Hospital Center, Washington, DC.

	Introduction

 
A61-year-old man with a history of coronary artery aneurysms was referred to our institution for evaluation of dyspnea on exertion. Coronary artery bypass of the aneurysms had been performed 2 years earlier. Although it was reported that the aneurysms had been ligated, coronary angiography revealed large residual aneurysms of the right and left circumflex arteries (top left, Figures 1 and 2), with patent bypass grafts. Computed tomography (CT) of the chest demonstrated that the aneurysms were >7 cm in diameter and lined with considerable thrombus (top right, Figures 1 and 2). Furthermore, impingement on the pulmonary artery by the enormous right coronary artery aneurysm was noted. Elevated pulmonary artery pressures of 45/25 mm Hg were documented during right heart catheterization.

View larger version (142K): [in this window] [in a new window]   Figure 1. Top left, Angiogram of giant right coronary artery aneurysm (RCA, arrowheads). Top right, CT of aneurysm (arrowhead). R indicates right ventricle; L, left ventricle. Bottom left, Two detachable balloons (arrows) occluding ostium of RCA aneurysm. Bottom right, Follow-up CT shows complete thrombosis of RCA aneurysm (arrowhead).

View larger version (138K): [in this window] [in a new window]   Figure 2. Top left, Angiogram of left circumflex artery aneurysm (LCx, arrow). Top right, CT of aneurysm (arrow). A indicates ascending aorta; P, pulmonary artery. Bottom left, Balloon (arrow) and coils (arrowhead) occluding ostium of LCx aneurysm. Bottom right, Follow-up CT shows complete thrombosis of LCx aneurysm (arrow).

The patient was considered to be at high risk for surgical reintervention; therefore, an endovascular approach was pursued. Two detachable latex balloons (Nycomed) were used to occlude the right coronary artery aneurysm . . . [Full Text of this Article]

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