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Coronary artery aneurysms in the elderly: Case report

Ricardo J Torres and Mahesh Changlani

Aneurysmal coronary disease or ectasia is defined as the dilation of a vessel at least 1.5 times the diameter of a normal adjacent segment. The prevalence of the disease has been encountered in up to 5% of patients undergoing angiographies. Atherosclerotic heart disease has been mentioned as the most common etiologic factor involved in the development of coronary aneurysms. We present a case of a 73-year-old male with a history of hypertension, dyslipidemia, and coronary artery disease with a myocardial infarction 20 years ago that was evaluated for dyspnea on mild exertion. There was no history of chronic lung disease. A left heart catheterization was done. This revealed a fusiform 14 mm aneurysm involving the whole left main (LM) coronary artery and multiple smaller aneurysms on the right coronary artery (RCA); there was also an 80% stenosis of the mid left anterior descending artery (LAD), a totally occluded left circumflex in its mid portion, and diffuse stenosis of the terminal branches of the RCA. The left ventricular ejection fraction was 35-40%. A single-vessel bypass grafting procedure with the left inferior mammary artery (LIMA) to the LAD was done. No surgical intervention was performed to the LM aneurysm due to the fusiform anatomy. On subsequent follow up the patient showed improvement of the symptoms and continued medical treatment with aspirin, statins, angiotensin receptor blockers and beta-blockers. The subsequent ejection fraction measured by echocardiography four months later, improved to 40-45%.