Korean Circ J.  2018 Jan;48(1):91-93. 10.4070/kcj.2017.0313.

Extrinsic Compression of the Left Main Coronary Artery by a Huge Aortic Arch Aneurysm Mimicking Acute Coronary Syndrome

• Shin JS
• Choi SY
• Lim SH
• Jung JH
• Kang DK
• Tahk SJ

• KMID: 2405053
• DOI: http://doi.org/10.4070/kcj.2017.0313

Abstract

No abstract available.

MeSH Terms

Acute Coronary Syndrome*
Aneurysm*
Aorta, Thoracic*
Coronary Vessels*

Figure

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  Figure 1 Findings of coronary angiography, IVUS and chest CTA. (A) Coronary angiography showing a bird beak-like significant narrowing of the ostium of the LMCA (yellow bold arrow). (B) IVUS demonstrated that the lumen of the LMCA ostium was deformed as a fusiform narrowing with mild atherosclerotic plaque surrounded by decreased echo-signals behind the vessel suspected of extrinsic compression (red arrows). (C, D) Immediate chest CTA revealed a huge 10×11 cm sized aortic arch aneurysm containing a mural thrombus (red asterisk) severely compressed right PA, left PA, left main-stem bronchus, and LMCA. CTA = computed tomographic angiogram; IVUS = intravascular ultrasound; LMCA = left main coronary artery; PA = pulmonary artery.

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  Figure 2 Surgical finding. Image taken during surgery revealing the giant aortic aneurysm containing a red thrombus. ACC = aortic cross clamp.

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  Figure 3 Findings of coronary angiography, IVUS and chest CTA after 4-vessel graft interposition. (A) After ascending aortic arch excision and graft interposition, coronary angiogram shows normal-looking appearance of the left coronary artery ostium. (B) IVUS shows the LMCA lumen was patent with minimal atherosclerotic plaque. (C-E) CTA shows significantly decreased size of aorta with focal dilatation, juxta distal to graft interposition site (4.6 cm) and patent lumens of both left and right PA with focal stenosis in proximal left PA. No definitive evidence of endoleak is shown in the graft interposition site. CTA = computed tomographic angiogram; IVUS = intravascular ultrasound; LMCA = left main coronary artery; PA = pulmonary artery.

Reference

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