Coronary artery aneurysm is an abnormal dilatation of part of the

coronary artery The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart muscle. The heart requires a continuous supply of oxygen to function and survive, much like any other tissue or organ of ...

. This rare disorder occurs in about 0.3–4.9% of patients who undergo coronary angiography.

Signs and symptoms

Causes

Acquired causes include

atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis in which the wall of the artery develops abnormalities, called lesions. These lesions may lead to narrowing due to the buildup of atheroma, atheromatous plaque. At onset there are usu ...

in adults,

Kawasaki disease Kawasaki disease is a syndrome of unknown cause that results in a fever and mainly affects children under 5 years of age. It is a form of vasculitis, where blood vessels become inflamed throughout the body. The fever typically lasts for more tha ...

in children and

coronary catheterization A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional (treatment) purposes. Coronary cathet ...

. With the invention of drug eluting stents, there has been more cases implying stents lead to coronary aneurysms. The pathophysiology, although not completely understood, might be comparable to that of aneurysms of larger vessels. This includes disruption of the arterial media, weakening of the arterial wall, increased wall strain and slow dilatation of the coronary artery portion. It can also be congenital. The following risk factors are thought to be associated with coronary artery aneurysms: # Individual's genetic make-up, especially in patients with congenital coronary artery aneurysms # Coronary artery disease (atherosclerosis) # Vasculitic and connective tissue diseases (Kawasaki and Marfan) # Intracoronary manipulation leading to local wall stress (stent placement, angioplasty, brachytherapy) # Post-infectious as a consequence of direct wall infiltration or immune complex deposition

Diagnosis

It is often found coincidentally on

coronary angiography Coronary () may, as shorthand in English, be used to mean: * Coronary circulation, the system of arteries and veins in mammals ** Coronary artery disease ** Coronary occlusion ** A myocardial infarction, a heart attack As adjective * Referring to ...

. Other modalities that can be used to diagnose a coronary artery aneurysm include echocardiography, magnetic resonance imaging and computerized tomography. Although coronary angiography remains to be the gold standard, the invasive procedure comes with its associated risks, is more expensive than other modalities and the size of the aneurysm might be miscalculated if there is a thrombus in place.

Treatment

Treatment for coronary artery aneurysm include medical management, surgery and percutaneous intervention. Underlying coronary artery risk factors should be addressed in patients with atherosclerosis and proper guideline-mediated medications should be started. In those with risk for embolism or thrombosis, anti-platelet or anticoagulation therapy should be contemplated. In patients with Kawasaki disease prompt administration of intravenous immunoglobulin (IVIG) therapy should be given to prevent complication of coronary artery aneurysm.

Prognosis

Generally, it has a good prognosis. In Kawasaki's disease, untreated, there is a 1–2% death rate, from cardiac causes. The prognosis of coronary artery aneurysm is dependent on its diameter. The smaller the aneurysm the better the prognosis. There is less risk for ischemic myocardial damage and mortality with smaller aneurysms. Aneurysms with an internal diameter > 8 mm have poorer outcomes, since these aneurysms can be occluded and be associated with complications such as arrhythmias, myocardial infarction, or sudden death.

References

External links

Diseases of the aorta Heart diseases {{circulatory-disease-stub