Localized Aneurysms of the Coronary Arteries

Coronary artery aneurysms discussed in the literature include generalized dilatation of the arteries associated with venous communications (1, 21, 23, 36, 41), dissecting aneurysms (5), and localized aneurysms (4, 8, 14, 40). To the best of our knowledge, of the 70 cases of localized aneurysms of the coronary arteries presented to date (4, 7, 17, 18, 20, 23, 25, 26, 30, 32, 36–38), not one has been diagnosed in vivo. This paper reports a case of localized aneurysms of the coronary arteries diagnosed by angiography. D. B., a white male infant, was born at term and weighed 9 lb. 8 oz. On March 1, 1966, at the age of nine months, a respiratory tract infection was treated. At 4 p.m. on March 11 he was heard to cry out, and on investigation his parents found him unconscious, cyanotic, and without respiratory efforts. Mouth-to-mouth respiration was attempted by the mother, and the child was rushed to the physician's office, where no heart beat or respiratory movements were identified. External cardiac massage was instituted successfully. At 4:30 p.m. when the infant was admitted to the Royal Island Hospital in Kamloops, B. C., he was breathing spontaneously and normally. Twelve hours later the boy had regained consciousness. On March 27 the child was transferred to St. Paul's Hospital in Vancouver for further studies. At this time he was an alert, active infant weighing 22 lb. There was no evidence of congestive cardiac failure, and auscultation of the heart revealed no abnormalities. No murmurs were audible, and the second pulmonary sound was soft and narrowly split. On examination the blood and urine were normal. An electrocardiogram was interpreted as that of an anterior wall infarction pattern. Roentgenograms of the chest in postero-anterior, lateral, and oblique views with barium in the esophagus disclosed no abnormality. Cardiac catheterization was performed March 30, 1966. Pressure measurements from both the right and left sides of the heart were normal. Blood oxygen analysis revealed no intracardiac shunt. Thoracic aortograms were obtained by injecting 10 cc of 76 per cent Renografin through a No. 6 French National Institute of Health catheter, the tip of which had been placed at the level of the aortic cusps, under 6 kg per cm2 of pressure. Films were obtained in the biplane projection at the rate of four frames per second. The examination revealed aneurysms of both coronary arteries (Fig. 1). At the age of fourteen months the child was asymptomatic, with a normal physical examination, but with a persistently abnormal ECG. Discussion The diagnosis of localized coronary artery aneurysm in the present case is believed to be the first made in vivo. It was initially suspected when the electrocardiogram revealed a myocardial infarction pattern which was confirmed by angiography. Conventional roentgenograms were not helpful but have been reported by Gore et al. (14) to show an occasional shell-like calcification of the wall of the aneurysm.