What Is a Coronary Artery Aneurysm?
Coronary arteries are locally or diffusely dilated, more than twice the original local diameter, and they are single or multiple tumor-like changes. Clinical manifestations are diverse and non-specific. This mainly depends on the pathological changes of the aneurysm itself and whether there are comorbidities. Its clinical manifestations can be symptoms and signs of angina pectoris or acute myocardial infarction. Heart failure can also occur with a large fistula. Patients with Kawasaki disease may be accompanied by persistent high fever, usually lasting more than 5 days, pharyngitis, hand and foot peeling, multiple erythema and cervical lymphadenopathy, bilateral conjunctivitis, etc.
- Visiting department
- Thoracic Surgery
- Common locations
- heart
- Common causes
- Coronary atherosclerosis, Kawasaki disease, severe cyanotic congenital heart disease, etc.
- Common symptoms
- Angina pectoris, acute myocardial infarction, heart failure, etc.
Basic Information
Causes of coronary aneurysms
- Coronary aneurysms are classified into congenital and acquired.
- Congenital coronary aneurysm
- The middle layer of the arterial wall showed segmental absence, muscular fiber dysplasia, and abnormal tissue arrangement. The diseased blood vessels continue to dilate and become thinner to form an aneurysm, or the cause of the disease is not clear, making the arterial wall cystic necrosis and degeneration. The middle layer invasion is particularly obvious. The elastic fibers are severely damaged to weaken the arterial wall and form an aneurysm. Aneurysms formed by coronary fistula.
- 2. Acquired coronary aneurysm
- (1) Coronary atherosclerosis is the most common cause of coronary aneurysms, accounting for 52% of aneurysms, and occurs more than 50 years of age. Mainly due to the disorder of lipid metabolism and hyperlipidemia, especially the abnormal increase of low-density lipoprotein, the first deposition of lipids on the endothelial layer of the blood vessel wall causes the destruction and fibrosis of endothelial cells, and then affects the middle-layer elastic fibers and the whole layer of blood vessels. , The nutrition of blood vessels is hindered, resulting in tearing of the intima of the tube wall, degeneration of the tube wall, local atrophy and fragility to form aneurysms.
- (2) Kawasaki disease This disease mainly affects children under 6 years of age, but it can also affect young people, of which 60% of patients develop heart malformations. Such as coronary aneurysms, coronary stenosis, myocarditis, or myocardial infarction, can also cause papillary muscle dysfunction and mitral regurgitation.
- (3) Secondary to severe onset of congenital heart disease. If a patient with severe onset of congenital heart disease survives to adulthood, the coronary arteries will diffuse diffusely due to the low level of oxygen saturation.
- (4) When the aortic valve is stenotic , the perfusion of the coronary arteries is not in the diastolic phase, but mainly occurs in the systolic phase of the ventricle, causing abnormal expansion of the coronary arteries.
- (5) Other causes In addition to the common causes mentioned above, coronary aneurysms can also be seen in advanced syphilis, sepsis after endocardial infection, neoplastic wounds, and scleroderma. It can also be secondary to coronary angioplasty or intracardiac surgery, such as endocardial biopsy, coronary artery bypass graft, and heart transplantation.
Clinical manifestations of coronary aneurysms
- 1. Clinical manifestations are diverse and non-specific.
- 2. It mainly depends on the pathological changes of the aneurysm itself, and whether there are comorbidities. Coronary aneurysms do not cause symptoms, and sometimes they are large and without any symptoms. They only happen occasionally during autopsy or coronary angiography. Its clinical manifestations can be the symptoms and signs of angina pectoris or acute myocardial infarction. Large fistula can also cause heart failure.
- 3. Into the pericardial cavity, acute pericardial tamponade occurred and died. Large coronary aneurysms may also show symptoms and signs of obstruction of the right ventricular outflow tract.
Coronary aneurysm
- Electrocardiogram
- Usually normal, it can also be manifested as ST-T changes or corresponding changes in acute myocardial infarction.
- 2. Heart X-ray
- Especially in the right heart margin occasionally abnormal changes in the contour of the heart can be found, or with aneurysm wall calcification, the disease can be suspected.
- 3. Echocardiography, CT, magnetic resonance
- It is very helpful for the correct diagnosis of coronary aneurysms.
- 4. Angiography or coronary angiography
- Can provide the most accurate diagnosis. Accurately provide information on the involvement of coronary arteries, the size and location of the aneurysm, the condition of the distal vascular bed, and whether there is a coronary fistula.
Coronary aneurysm diagnosis
- Patients with coronary aneurysms often have no clinical symptoms, and the ECG can be normal. The physical examination may be without any positive signs. Corresponding clinical symptoms and signs do not appear until complications occur (such as coronary artery thrombosis, myocardial infarction, etc.), so early diagnosis is difficult. Generally, young patients (especially around 20 years old) should think of acute myocardial infarction The possibility of this disease.
- To further examine the heart X-ray, echocardiography, etc., especially ascending aorta angiography and selective coronary angiography, can provide direct imaging signs to provide a basis for diagnosis and later surgical treatment.
Coronary Aneurysm Treatment
- Coronary aneurysms, whether simple or secondary to coronary fistula, require surgical treatment upon diagnosis. Coronary aneurysms caused by Kawasaki disease generally do not require surgery, and treatment with aspirin and -globulin can achieve significant results.
- Coronary aneurysm surgery needs to be performed under low-temperature extracorporeal circulation. The aneurysm is resected or the two ends of the tumor are ligated, and the saphenous vein or internal mammary artery is bypassed.
- For patients with concurrent acute coronary artery thrombosis or myocardial infarction, thrombolytic therapy can be taken, and the thrombus is dissolved by intravenous or coronary injection of streptokinase or urokinase. Those who are not satisfied with the effect of thrombolytic therapy still need surgery.