Coronary artery aneurysms (CAA's) are an uncommon, predominantly incidental finding.
CAA is most common in men 3, likely reflecting the increased rates of atherosclerosis in men compared to women. Prevalence varies in the literature between 0.1-5% 4.
Most coronary artery aneurysms are asymptomatic. They can be associated with cardiac murmurs or present with chest pain or congestive cardiac failure.
Coronary artery aneurysms are defined as a focal dilatation of the coronary artery by at least 50% compared to a nearby artery or adjacent arterial segment and involve <50% of the artery length 2,4. They can be further classified by 4:
Coronary artery ectasia when there is dilatation but it involves >50% of the artery length 4. The subtype, giant coronary artery aneurysms, measure > 2 cm in diameter.
They may be associated with coronary arteriovenous fistulas to either cardiac veins (see case 3) or cardiac chambers.
- atherosclerosis (50%)
- congenital (17%)
- mycotic, e.g. syphilis (10%)
- vasculitis, e.g. Kawasaki disease (more common in Japan)
- connective tissue disorders, e.g. systemic lupus erythematosus
- iatrogenic, e.g. stent placement
Treatment and prognosis
There is no established treatment for CAA with medial and surgical options available 4. The five-year survival of CAA is ~70% 3,4.
- 1. Everett JE, Burkhart HM. Coronary artery aneurysm: case report. J Cardiothorac Surg. 2008;3 (1): 1. doi:10.1186/1749-8090-3-1 - Free text at pubmed - Pubmed citation
- 2. Everett JE, Burkhart HM. Coronary artery aneurysm: case report. J Cardiothorac Surg. 2008;3 (1): 1. doi:10.1186/1749-8090-3-1 - Free text at pubmed - Pubmed citation
- 3. Eisa N, Alamiry MR, Alraiyes AH et-al. Right coronary artery aneurysm: an unusual cause of chest pain. BMJ Case Rep. 2013;2013 (may22 1): . doi:10.1136/bcr-2013-010095 - Free text at pubmed - Pubmed citation
- 4. Díaz-Zamudio M, Bacilio-Pérez U, Herrera-Zarza MC et-al. Coronary artery aneurysms and ectasia: role of coronary CT angiography. Radiographics. 2009;29 (7): 1939-54. doi:10.1148/rg.297095048 - Pubmed citation
- 5. Syed M, Lesch M. Coronary artery aneurysm: a review. Prog Cardiovasc Dis. 1997;40 (1): 77-84. Pubmed citation