Sometimes You Have to Go Back to the Beginning

If you do enough diagnostic cardiac catheterizations, you expect to see a few coronary anomalies or unusual coronary anatomies such as the multivessel giant aneurysms described in our case report in this month’s issue of the Journal of Invasive Cardiology. We typically view these as interesting findings and then consider them only in the context of how it will affect our approach to a percutaneous coronary intervention. In this case, the coronary anatomy was so unusual that it prompted us to reconsider entirely what we knew about our patient and his clinical history. Our 54-year-old patient had a prior history of hypertension and renal insufficiency. He presented with a complicated acute coronary syndrome that brought him to the cardiac catheterization laboratory based on the assumption that garden variety atherosclerosis caused his ischemia. His angiogram was remarkable for the multivessel giant coronary aneurysms (seen in ~0.0012% of cases) that were found. Because this finding is so rare, especially when it involves the left main coronary artery, we suspected an underlying vasculitis as the cause of this patient’s vasculopathy. A workup for the usual vasculitis-related causes of coronary aneurysms in adults was unrevealing. Only after obtaining the history of a childhood hospitalization that was consistent with Kawasaki disease from the patient’s parents was this typically childhood disease considered as a possible etiology of the aneurysms. This also led us to consult a pediatric cardiologist who was able to provide the appropriate context for the diagnosis. Kawasaki disease is the most common cause of acquired coronary artery aneurysms and ~25% of children that are not treated will end up with this problem because of persistent subacute vasculitis. This subacute vasculitis can last for years and predispose individuals with the disease to ischemia. Our case illustrates the importance of considering the manifestations of childhood diseases in adults and remembering to include our pediatric cardiologist colleagues in these discussions.

Jane A. Leopold, MD
Director of the Women’s Interventional Cardiology Health Initiative at Brigham and Women’s Hospital and Harvard Medical School

Read the entire case report at:

Kaneko T, Newburger JW, Leopold JA. Multivessel Giant Coronary Artery Aneurysms in an Adult With an Acute Coronary Syndrome: Latent Finding of Kawasaki Disease. J Invasive Cardiol 2014;26(9):E127-E129.

Read more about giant coronary artery aneurysms at:

Sharma J, Kanei Y, Kwan TW. A Case of Giant Coronary Artery Aneurysm after Placement of a Heparin-Coated Stent. J INVASIVE CARDIOL 2009;21:E22–E23.

Silva JC, Lopes R. Percutaneous Exclusion of a Giant Coronary Artery Aneurysm Using Two Covered Stents. J INVASIVE CARDIOL 2009;21:E119–E121.

Hillegass WB, Gupta H, Katragadda R, Knoblauch J, Coghlan C, Misra VK. Ruptured Giant Right Coronary Artery Aneurysm Percutaneously Plugged. J INVASIVE CARDIOL 2007;19(3):139-141.

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