PMC5831309_01
(A and B) Echocardiography: ejection fraction 68%; left atrium 35 mm;
septum 8mm; posterior wall 8mm; left ventricular diastolic diameter
45mm; left ventricular systolic diameter 30 mm; PSAP 40 mmHg.
Dilatation of left coronary artery (7 mm). Left ventricle with
preserved systolic function and myocardial thickness, with no
changes in segmental wall motion. (C and D) Cardiac catheterization
(10/2013): coronary artery ectasia. Dominant coronary with 50%
proximal, eccentric tubular lesion and coronary thrombosis; left
coronary artery trunk with aneurysmatic dilatation at the distal
third; anterior descending artery with ectasia at the proximal
third, without obstructive lesions. Circumflex artery with proximal
ectasia, without obstructive lesions.
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f1
The patient had a history of ST-elevation myocardial infarction of inferior wall at the age of 30, with giant aneurysms and coronary artery thrombosis evidenced by coronary angiography (Figure 1C and 1D). Regarding complementary tests, electrocardiography showed sinus rhythm with diffuse ventricular repolarization; transthoracic echocardiogram is depicted in Figure 1A and 1B.
Coronary computed tomography angiography showed aneurysm at the
distal third of the left coronary artery trunk (9mm) and anterior
descending artery ostium (9.5 mm); circumflex artery with ectasia at
the ostium (3.7 mm); marginal branch 2 with aneurysm at the distal
segment; right coronary artery with saccular aneurysm (9.8 mm at the
greatest diameter), mural thrombus and small regions of
calcification. Total score of 23.81 (Agaston) and 38.59 (Volume).
MT: main trunk of the left coronary artery; DA: anterior descending
artery; DB: diagonal branch; CA: circumflex artery; M1: left
marginal artery; M2: second marginal branch of circumflex artery;
RCA: right coronary artery; LA: left atrium; Ao: aorta
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f2
The patient underwent coronary computed tomography angiography, which confirmed the previous findings, with evidence of coronary artery ectasia with multiple aneurysmatic dilatations and mural thrombus (Figure 2).