Chest
Volume 69, Issue 5, May 1976, Pages 630-636
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Clinical Investigations
Coronary Artery Aneurysm: A Review of the Literature with a Report of 11 New Cases

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In a prospective study, 11 (1.5 percent) of 742 patients had angiographically proven coronary artery aneurysms. The clinical picture was similar to that of patients with severe coronary artery disease. The coronary artery aneurysms were multiple and were associated with extensive coronary atherosclerosis in ten of the 11 patients. Left ventricular function was impaired when measured by end-diastolic pressure, end-diastolic volume, and ejection fraction. Segmental left ventricular contraction was severely abnormal. The abnormality of segmental contraction, distribution of coronary artery obstructions, and presence of collateral circulation were not different from other patients with severe occlusive coronary atherosclerosis. These 11 cases plus the 23 previously reported ante mortem form the total reported in world literature. The etiology of coronary artery aneurysms is most commonly atherosclerosis (17/34, or 50 percent). The natural history of this condition is not known. Because of the severe atherosclerosis and poor distal-vessel run-off, most patients are not considered good surgical candidates; however, 15 patients have had coronary arterial surgery, and 13 have survived the immediate postoperative period with some improvement of symptoms.

Section snippets

Methods

The clinical features and the angiographic and hemodynamic findings were evaluated in 11 patients with aneurysms of the coronary arteries. All patients included in this prospective study were part of a larger series of patients (742) who had been referred for cardiac catheterization and coronary arteriographic studies from July 1, 1973 through April 1, 1975. Informed consent was obtained from all patients. Catheterization was performed with patients in the fasting state, under mild sedation

Clinical History

Clinical data are presented in Table 1. The ages of the patients (ten men and one woman) ranged from 35 through 69 years. The duration of symptoms ranged from one month to 14 years. Eight of the 11 patients had unstable angina pectoris; and in two patients the pattern of angina, although not changing, was refractory to medical therapy. All patients had classic histories of angina pectoris; and in five patients, there were clear histories of previous myocardial infarction documented both by

Incidence

The incidence of coronary artery aneurysms has been reported at 0.3 percent during life26 and 1.4 percent at death (from a review of 644 consecutive autopsies5). In the present study the 11 cases were recognized from a larger group of 742 cases, a percentage of 1.5. Previously, this condition was thought to be extremely rare. But as demonstrated by Table 2, only six cases were recognized before 1970, and 28 cases since 1970. The rate of recognition probably parallels the increased use of

Acknowledgment

We wish to acknowledge the technical assistance of Mr. James A. Cramer and Mr. Rick A. Lenth in the preparation of this manuscript.

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Supported in part by grants from the Iowa Heart Association and the Veterans Administration, and by National Institutes of Health grant HL 014388.

Manuscript received October 3; revision accepted November 21.

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