Spontaneous Healing Of Posttraumatic Focal Coronary Aneurysm: A Case Report
Miwa, K., Matsubara, T., Yasuda, T., Inoue, M., Teramoto, R., Kinoshita, H., Okada, H., Yakuta, Y., Kanaya, H., Kawashiri, M., & Yamagishi, M. (2012). spontaneous healing of posttraumatic focal coronary aneurysm: a case report. heart & lung : the journal of critical care, 41(6), 613–616. https://doi.org/10.1016/j.hrightlng.2011.09.004
View Original Source →Case Details
Disease Location
Aneurysm at proximal part of the left anterior descending artery
Personal Characteristics
61-year old man WHO had been in a motor vehicle accident in which his chest had suffered impact against the steering wheel
Clinical Characteristics
Area of contusion over left sternal border; radiography showed slightly enlarged heart; ecg on admission showed normal results except for poor r-wave progression in chest leads; patient reported intermittent, non-specific chest pain, ecg on day 6 after injury showed negative t-wave in left chest leads and echocardiography revealed area of severe hypokinesia in anterior apical walls with mildly pericardial echo-free space around heart; on day 35 after injury, left-sided cardiac catheterization with selective coronary angiography showed aneurysm at the proximal part of the left anterior descending artery (lad), ivus showed aneurysm with disrupatiention of the external elastic membrane at the proximal part of the lad (diagnosed as pseudoaneurysm), resting thallium-201 myocradial perfusion scintigraphy revealed decreased tracer uptake in the anterior wall of left ventricle (consistent with subendocardial infarction or myocardial contusion of lad area)
Remission Characteristics
Follow up angiography 3 months after hospital discharge (59 days after injury) showed reduction in size of pseudoaneurysm in proximal lad, patient was fully mobile and asymptomatic with no signs of residual ischemia; cardiac status reamined at new york heart association class i for more than 3 years after injury
Treatment & Mechanisms
Proposed Remission Mechanisms
Pseudoaneursym protruded toward the myocardium but not the epicardium, which would be advantageous in avoiding rupture because of the increased aneurysmal strength created by the extravascular fibrous tissue against the expansive force of the intraluminal pressure; possible spontaneous healing of coronary artery disrupatiention with thrombosis of the aneurysm may be responsible
Clinical Treatment
"""conservative"" treatment"
Non-Clinical Treatment
None reported discussed