Thrombosis of a Coronary Artery Aneurysm in a Young Man Presenting With Acute Myocardial Infarction
A 27-year-old avid amateur basketball player was brought to the emergency room after suddenly collapsing at work. ECG showed ST-segment elevation in leads of the inferior-posterior wall. A transthoracic echocardiogram revealed severely diminished contraction of the left ventricle (25% ejection fraction) and a space-occupying lesion in the anterior atrioventricular groove. Urgent cardiac catheterization demonstrated an ectatic left anterior descending coronary artery, without evidence of stenoses, and an ectatic right coronary artery that was occluded proximally (Figure, A and B). The patient was admitted to the cardiac intensive care unit with the diagnosis of acute inferior-posterior wall myocardial infarction. He underwent ECG-gated coronary computerized tomographic angiography with a 16-slice multidetector spiral computed tomography scanner (Mx8000 IDT, Philips Medical Systems), which revealed that the lesion in the anterior atrioventricular groove was actually a huge thrombosed aneurysm of the right coronary artery. In addition, 2 sequential aneurysms of the proximal and middle left anterior descending artery were demonstrated (Figure, C and D). To prevent distal embolization, the left coronary artery was ligated, and bypass grafting to the distal left anterior descending, diagonal, and posterior descending coronary arteries was performed (Figure, E and F). Five days after an uneventful postoperative period, the patient was discharged.