Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature
Abstract Background A coronary artery aneurysm (CAA) is an abnormal dilation of a coronary artery segment often accompanied by coronary artery fistula (CAF), leading to communication between a coronary artery and a cardiac chamber or a part of the coronary venous system. Both CAAs and CAFs can prese...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | BMC Cardiovascular Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12872-024-03851-w |
| _version_ | 1797220069842878464 |
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| author | A. Vassilikou MP Xenitopoulou K. Ziampa AP Evangeliou S. Mitsiadis A. Syrnioti G. Petrakis P. Tossios V. Vassilikos S. Tzikas |
| author_facet | A. Vassilikou MP Xenitopoulou K. Ziampa AP Evangeliou S. Mitsiadis A. Syrnioti G. Petrakis P. Tossios V. Vassilikos S. Tzikas |
| author_sort | A. Vassilikou |
| collection | DOAJ |
| description | Abstract Background A coronary artery aneurysm (CAA) is an abnormal dilation of a coronary artery segment often accompanied by coronary artery fistula (CAF), leading to communication between a coronary artery and a cardiac chamber or a part of the coronary venous system. Both CAAs and CAFs can present with symptoms and signs of myocardial ischemia and infarction. Case presentation We describe the case of a 46-year-old woman with non-ST-elevation myocardial infarction (NSTEMI) caused by a “giant” CAA. Various imaging modalities revealed a thrombus-containing aneurysm located at the right-posterior cardiac border, with established arteriovenous communication with the distal part of left circumflex artery (LCx). After initial treatment with dual antiplatelet therapy, a relapse of pain was reported along with a new increase in troponin levels, electrocardiographic abnormalities, reduced left ventricular ejection fraction (LVEF) and thrombus enlargement. Surgical excision of the aneurysm was favored, revealing its true size of 6 cm in diameter. Τhe aneurysm was excised without complications. The patient remained asymptomatic during follow-up. Conclusions Management of rare entities such as “giant” CAAs and CAFs can be challenging. Cases such as this can serve as precedents to facilitate treatment plans and develop consistent recommendations, emphasizing the importance of personalized strategies for future patients. |
| first_indexed | 2024-04-24T12:43:41Z |
| format | Article |
| id | doaj.art-75935c9a4b964ef185dee2385998cf4e |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-04-24T12:43:41Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-75935c9a4b964ef185dee2385998cf4e2024-04-07T11:07:42ZengBMCBMC Cardiovascular Disorders1471-22612024-04-012411610.1186/s12872-024-03851-wAcute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literatureA. Vassilikou0MP Xenitopoulou1K. Ziampa2AP Evangeliou3S. Mitsiadis4A. Syrnioti5G. Petrakis6P. Tossios7V. Vassilikos8S. Tzikas93rd Department of Cardiology, “Hippokration” General Hospital of Thessaloniki, Aristotle University of Thessaloniki3rd Department of Cardiology, “Hippokration” General Hospital of Thessaloniki, Aristotle University of Thessaloniki3rd Department of Cardiology, “Hippokration” General Hospital of Thessaloniki, Aristotle University of Thessaloniki3rd Department of Cardiology, “Hippokration” General Hospital of Thessaloniki, Aristotle University of Thessaloniki3rd Department of Cardiology, “Hippokration” General Hospital of Thessaloniki, Aristotle University of ThessalonikiPathology Department, “AHEPA” University Hospital of Thessaloniki, Aristotle University of ThessalonikiPathology Department, “AHEPA” University Hospital of Thessaloniki, Aristotle University of ThessalonikiCardiothoracic Surgery Department, “Hippokration” General Hospital of Thessaloniki, Aristotle University of Thessaloniki3rd Department of Cardiology, “Hippokration” General Hospital of Thessaloniki, Aristotle University of Thessaloniki3rd Department of Cardiology, “Hippokration” General Hospital of Thessaloniki, Aristotle University of ThessalonikiAbstract Background A coronary artery aneurysm (CAA) is an abnormal dilation of a coronary artery segment often accompanied by coronary artery fistula (CAF), leading to communication between a coronary artery and a cardiac chamber or a part of the coronary venous system. Both CAAs and CAFs can present with symptoms and signs of myocardial ischemia and infarction. Case presentation We describe the case of a 46-year-old woman with non-ST-elevation myocardial infarction (NSTEMI) caused by a “giant” CAA. Various imaging modalities revealed a thrombus-containing aneurysm located at the right-posterior cardiac border, with established arteriovenous communication with the distal part of left circumflex artery (LCx). After initial treatment with dual antiplatelet therapy, a relapse of pain was reported along with a new increase in troponin levels, electrocardiographic abnormalities, reduced left ventricular ejection fraction (LVEF) and thrombus enlargement. Surgical excision of the aneurysm was favored, revealing its true size of 6 cm in diameter. Τhe aneurysm was excised without complications. The patient remained asymptomatic during follow-up. Conclusions Management of rare entities such as “giant” CAAs and CAFs can be challenging. Cases such as this can serve as precedents to facilitate treatment plans and develop consistent recommendations, emphasizing the importance of personalized strategies for future patients.https://doi.org/10.1186/s12872-024-03851-wCoronary artery aneurysmCoronary artery fistulaGiant coronary artery aneurysmMyocardial infarctionNSTEMICase report |
| spellingShingle | A. Vassilikou MP Xenitopoulou K. Ziampa AP Evangeliou S. Mitsiadis A. Syrnioti G. Petrakis P. Tossios V. Vassilikos S. Tzikas Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature BMC Cardiovascular Disorders Coronary artery aneurysm Coronary artery fistula Giant coronary artery aneurysm Myocardial infarction NSTEMI Case report |
| title | Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature |
| title_full | Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature |
| title_fullStr | Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature |
| title_full_unstemmed | Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature |
| title_short | Acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula: a challenging case report and review of the literature |
| title_sort | acute myocardial infarction due to giant coronary artery aneurysm and arteriovenous fistula a challenging case report and review of the literature |
| topic | Coronary artery aneurysm Coronary artery fistula Giant coronary artery aneurysm Myocardial infarction NSTEMI Case report |
| url | https://doi.org/10.1186/s12872-024-03851-w |
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