alexa Surgery for an Isolated Huge Coronary Artery Aneurysm in a Patient with Behcets Disease: Case Report and Review of the Literature | Open Access Journals
ISSN: 2155-9880
Journal of Clinical & Experimental Cardiology
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Surgery for an Isolated Huge Coronary Artery Aneurysm in a Patient with Behcets Disease: Case Report and Review of the Literature

Ben Jmaa Hela1*, Dhouib Faten1, Dammak Aiman1, Bouassida Abir1, Ghorbel Nesrine1, Souissi Iheb2, Kallel Rahma3, Masmoudi Sayda1, Elleuch Nizar1 and Frikha Imed1
1Department of Cardiovascular and Thoracic Surgery, Habib Bourguiba Hospital Sfax, Tunisia
2Department of Anesthesiology, Habib Bourguiba Hospital Sfax, Tunisia
3Department of Cardiology, Hedi Chaker Hospital Sfax, Tunisia
*Corresponding Author : Ben Jmaa Hela
Department of Cardiovascular and Thoracic Surgery
Habib Bourguiba Hospital Sfax, Tunisia
Tel: 0021696704740
E-mail: [email protected]gmail.com
Received date: March 05, 2016; Accepted date: April 05, 2016; Published date: April 15, 2016
Citation: Hela BJ, Faten D, Aiman D, Abir B, Nesrine G, et al. (2016) Surgery for an Isolated Huge Coronary Artery Aneurysm in a Patient with Behcet’s Disease: Case Report and Review of the Literature. J Clin Exp Cardiolog 7:430. doi:10.4172/2155-9880.1000430
Copyright: © 2016 Hela BJ, et al. This is an open -access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Coronary artery aneurysms in patients with Behcet’s disease are rare. Giant aneurysms defined as greater than 2 cm are exceptional. We are reporting a rare case of a 33-year-old man with Behcet’s disease, admitted for chest pain, whose coronary angiogram revealed a huge aneurysm involving the proximal segment of proximal left anterior descending artery followed by a severe stenosis. The aneurysm was successfully resected and an arterial coronary bypass was performed. The patient was asymptomatic in the postoperative period.

Abstract

Coronary artery aneurysms in patients with Behcet’s disease are rare. Giant aneurysms defined as greater than 2 cm are exceptional. We are reporting a rare case of a 33-year-old man with Behcet’s disease, admitted for chest pain, whose coronary angiogram revealed a huge aneurysm involving the proximal segment of proximal left anterior descending artery followed by a severe stenosis. The aneurysm was successfully resected and an arterial coronary bypass was performed. The patient was asymptomatic in the postoperative period.
Keywords

Aneurysm; Coronary artery; Behcet’s disease; Bypass
Introduction

Behcet’s disease is a systemic vasculitic syndrome with a variety of clinical manifestations [1].

Coronary artery aneurysms are defined as a localized dilation exceeding the diameter of an adjacent normal segment by 50% [2]. They are rarely associated with this disease, and can be associated with fatal complications [3].

We report an exceptional case of isolated coronary artery aneurysm with severe stenosis in a patient with Behcet’s disease, treated surgically.
Case Presentation

This case describes a 33-year-old man with Behcet’s disease, and no cardiovascular risk factors, who was admitted to the department of cardiology for chest pain since 2 days.

Chest auscultation detected no murmur, and no signs of heart failure.

Electrocardiogram showed an antero-septo-apical ST-segment elevation. Laboratory analyses showed elevated cardiac troponin I, with biological inflammatory syndrome.

Chest radiography showed an abnormally prominent left heart border.

Trans-thoracic echocardiography was suggestive of a large spherical mass adjacent to the lateral wall of the left ventricle, with normal left ventricular systolic function.

Thoracic computed tomography scan confirmed that the mass was a non- ruptured aneurysm of the proximal left anterior descending artery measuring 40 × 60 mm and compressing the pulmonary artery, without dilatation of the aorta.

Coronary angiography showed an aneurysmal dilation of the proximal segment of the left anterior descending artery followed by a severe stenosis. The aneurysm measured 3 cm of diameter.

No other aneurysm or stenosis was detected.

The patient underwent surgery through a median sternotomy under cardiopulmonary bypass established through cannulation of the ascending aorta and the right atrium. Macroscopic examination confirmed a huge aneurysm compressing the pulmonary artery.

Surgery included resection and ligation of the giant aneurysm (Figures 1-3). Then, a bypass grafting of the left anterior descending artery using the left internal mammary artery was performed (Figure 4).

Weaning from cardiopulmonary bypass was easy, without catecholamine’s.

Postoperative transthoracic echocardiography showed good cardiac function.

The postoperative hospital course was unremarkable. He was continued on aspirin, corticosteroids, and immunosuppressive medication.

The patient was discharged from hospital 4 days after surgery.

Histopathological assessment of the excised aneurysm revealed an inflammatory cell infiltration suggestive of vasculitis.
Discussion

Coronary artery aneurysms are rare, with a reported prevalence of 0.15 to 4.9% of all patients undergoing coronary angiography [4,5].

Their main etiologies include atherosclerosis, Kawasaki disease, infection, trauma, and congenital conditions [5]. The Behcet’s disease is an extremely rare cause of this kind of aneurysms [6].

The right coronary artery seems to be the most commonly involved, followed by the left anterior descending artery [7].

Giant aneurysms, whose diameter is over 20 mm, are more infrequent, and considered to be at increased risk of rupture into the pericardium, compression of surrounding organs, and thromboembolism [5].

So, patients with enlarging aneurysms should be treated even if they are symptomatic.

There is no consensus upon the management of coronary aneurysms in patients with Behçet’s disease because of the rarity and unpredictable natural history of this condition [1].

The closure of the coronary aneurysm should be considered case to case in view of the related risk of thrombosis or rupture. Surgery has been recommended for high-risk giant aneurysms [8].

Percutaneous approaches with covered stents and coil embolization have been reported for the management of these patients with adequate use of immunosuppressant and anticoagulant therapy [1,9,10].
Conclusion

This case report highlighted the presence of giant coronary aneurysm, and stenosis in a patient with Behcet’s disease.

Surgical intervention appears to be the treatment of choice for these aneurysms.
 
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Review summary

  1. Andrea
    Posted on Aug 03 2016 at 1:38 pm
    The manuscript deals with an interesting topic on which there isn't any consensus due to inefficient management and rarity of the disease. The methods of treatment elaborated in the article will help practicing cardiologists to make correct decisions in the times of emergencies.
 

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