Article Text

Severe aneurysmal coronary artery disease
  1. JAN S JÜRGENSEN,
  2. MICHAEL SCHLEGL,
  3. JÜRGEN HUG
  1. jan_steffen.juergensen{at}charite.de

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A 59 year old white man was admitted to our hospital because of unstable angina. His past medical history was significant for an inferior myocardial infarction at the age of 52, hypertension, and hyperlipidaemia.

Coronary angiography was performed revealing severe aneurysmal coronary artery disease. The right anterior oblique projection (left) showed multiple aneurysms alternating with severe stenoses of the left anterior descending and circumflex coronary arteries. The left anterior oblique view (right) showed a large saccular aneurysm in the proximal segment of the right coronary artery as well as coronary ectasia and stenoses along the vessel. He underwent three vessel coronary artery bypass grafting with a left internal mammary artery to the left anterior descending artery and aneurysmectomy of the right coronary artery.

Coronary artery ectasia (CAE) is an uncommon angiographic finding. The description of this disease in a syphilitic patient in the anatomical works of Giambattista Morgagni (1682–1771) is probably the earliest in the literature. In various other reports, CAE has been described either as an isolated congenital lesion or in association with Kawasaki's disease (mucocutaneous lymph node syndrome), scleroderma, polyarteritis nodosa, Ehlers-Danlos syndrome, hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu), bacterial infection, and familial hypercholesterolaemia.

However, like in our patient, the vast majority of CAE is generally not a distinct anatomical or functional abnormality but an accompaniment or a variant of atherosclerotic coronary artery disease with which it usually coexists.

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