Aneurysm – ABC CARDIOL

ABCIC

Case Report

Aneurysm of the Suprahepatic Inferior Vena Cava: A Case Report

Gabriella Ghattas Mariano et al. Calina Araujo Thaines Gabrielle Silva Desani Letícia de Castro Gouvêa … Paulo Vítor Cabral Covilo Rogério de Paula Garcia Caravante

Introduction

Aneurysms of the inferior vena cava (IVC) are a rare occurrence in the cardiovascular system and can present with a variety of signs and symptoms. In many cases, patients remain asymptomatic, which makes diagnosis difficult. Venous aneurysms are defined as an abnormal and persistent dilation of a vein in a specific area, with a diameter at least twice that considered normal. An IVC aneurysm is a specific type of venous aneurysm. This case report is relevant because this condition is rare; by 2021, only around 70 cases had been described in literature.

Aneurysms may arise due to fragility in the vessel wall and can be triggered by various factors, including hypertension, trauma, infection, and genetic conditions. Smoking, atherosclerosis, and chronic obstructive pulmonary disease are also considered risk factors for aneurysm development. Although they can occur in different regions of the body, they most frequently affect the cerebral arteries, the aorta, and the peripheral arteries.

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IJCS

Case Report

Left Pulmonary Artery Aneurysm in an Adult Patient With Uncorrected Tetralogy of Fallot and Patent Ductus Arteriosus: A Case Report

Miguel Bernardino Antunes Vicente et al. Elsa Fernandes Roger Dopico Luis Mariano … Odete Mingas Domingos Ramos Lino Gonçalves

Abstract

The authors describe a case of an infrequent triple association: left pulmonary artery aneurysm (PAA), uncorrected tetralogy of Fallot (TOF) and patent ductus arteriosus (PDA), diagnosed in a 45-year-old adult patient during a check-up. The patient refused to undergo surgery and is currently being followed clinically.

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Crawford 2 Thoracoabdominal Aneurysm Associated with Bicarotid Trunk and Aberrant Right Subclavian Artery

Milton Sérgio Bohatch Junior et al. Fernando Reis Neto Daniel Gustavo Miquelin Andre Rodrigo Miquelin … Henrique Amorim Santos Amanda Fernandes Vidal da Silva Luiz Fernando Reis Jose Maria Pereira de Godoy

A 73-year-old woman with a history of hypertension was referred to the vascular surgery department for severe chest pain and signs of shock, including tachycardia and a tendency toward hypotension. An angiotomography revealed a thoracoabdominal aneurysm (Crawford Classification type 2 – ) with rupture signs ( and ) and anatomical variations in the supra-aortic trunks, including an aberrant right subclavian artery (ARSA) ( and ) and a bicarotid trunk (). She underwent emergency surgery with a hybrid approach, which included visceral branching via laparotomy and endovascular repair of the aneurysm. Unfortunately, she developed hemodynamic instability and refractory shock during the procedure, resulting in death. Her family authorized the publication and signed the consent form.

An ARSA is a rare anomaly with a 0.2% to 13.3% prevalence.^, It is more common among females, individuals with congenital anomalies (up to 3%), and those with Down syndrome (up to 35%). ARSA may be associated with a bicarotid trunk in 0.8% to 20% of cases, where common carotid arteries originate from the same point on the aortic arch. Thoracoabdominal Aortic Aneurysms (TAAAs) represent 10% of all aortic aneurysms. These aneurysms are potentially fatal if not treated early, as they may progress to rupture or dissection. In a São Paulo epidemiological study, the mortality rate for emergency TAAA repairs was nearly double that of elective repairs (42.10% vs. 26.78%). This difference is often attributed to the hemodynamic instability of ruptured aneurysms and the lack of timely preoperative preparation in urgent cases. Anatomical assessment is essential for treating TAAAs, whether through open surgery, endovascular surgery, or hybrid techniques. Anatomical variations in the supra-aortic trunks increase surgical complexity, regardless of the chosen technique.

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ABCIC

Case Report

Takayasu’s Arteritis: Ascending Aortic Aneurysm and Coronary Artery Disease in a 19-year-old Young Adult

Iuri Betuel Gomes António et al. Adnaldo da Silveira Maia Janayna Rabelato Aloysio Abdo Silva Campos … Marilia Prudente Menezes Mário Issa

Abstract

Takayasu’s Arteritis (TA) is a disease of multiple presentation, which can involve many different systems and mainly affects women in the first decades of life. The present case reports on a 19-year-old patient with TA, with a diagnosis of ascending aortic aneurysm and severe coronary artery disease in the right coronary artery (RCA) and left coronary trunk (LCT), who underwent an implant of a supracoronary Dacron graft in the ascending aorta and myocardial revascularization with a double internal thoracic artery. The patient evolved satisfactorily in post-op and is today undergoing clinical follow-up in our medical services.

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ABCIC

Case Report

Late Diagnosis of Kawasaki Disease and its Complications. Case Report

Layanne Sousa Cruz Martins et al. Mila Simões Alves Paloma Cheab Ribeiro Moura Costa Naiara Galvão de Araújo Alcântara

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Left Ventricular Aneurysm

Larissa Mezerhane da Silva et al. Adriana Furletti Machado Guimarães Fátima Derlene da Rocha Araújo

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ABCIC

Case Report

Coronary-Cameral Fistula and Aneurysmal Dilatation of the Anterior Descending Artery: A Case Report

Ariane Silveira Fusco et al. Adriana de Nazaré Miziara Oliveira Valéria Cardoso Alves Cunali Fabio Vieira Fernandes Fabiana Jorge Bueno Galdino Barsam

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Association among Subaortic Membrane, Interventricular Membranous Septal Aneurysm, and Septal Defect

Israel Nilton de Almeida Feitosa

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ABC

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A Very Complicated Inferior Myocardial Infarction: The Role of Multimodality Imaging Approach

Inês Cruz et al. Carlos Cotrim Luís Lopes Paula Fazendas Hélder Pereira

A 47-year-old male presented with a subacute inferior myocardial infarction (MI) complicated by inferobasal ventricular septal rupture (VSR) and underwent emergency surgical repair of VSR with a pericardial patch. In the postoperative period he remained hypotensive, with low exercise tolerance and a holosystolic murmur was present. Echocardiography showed persistence of VSR with left-right shunt () and revealed an aneurysmatic region at the inferobasal wall of the left ventricle (LV), suggestive of a true aneurysm due to its large “neck” and smooth transition from normal myocardium to the aneurysm ( and ). Cardiac magnetic resonance confirmed the VSR ( and ) with significant shunt (Qp/Qs of 2.3), showed transmural necrosis of the basal and mid segments of the inferior and free wall of the right ventricle with moderate systolic dysfunction and also revealed that the aneurysmatic inferobasal region of LV was actually a pseudoaneurysm, without myocardial tissue but with a sessile and adherent thrombus within it ( and ).

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ABC

Relato de Caso

Chronic left ventricular pseudoaneurism of undetermined etiology

Guilherme Loureiro Fialho et al. Cláudio Henrique Fischer Adriana Cordovil Orlando Campos Filho

Pseudoaneurysms occur as a rare complication of the myocardial infarction, of which hemorrhagic process is contained by adherences of the visceral or parietal pericardium – or of both – preventing the development of cardiac tamponade. We report the case of a 55-year-old patient, with a chronic left ventricular pseudoaneurysm of undetermined etiology, who was submitted to a conservative treatment.

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Case Report

Right Sinus of Valsalva Aneurysm causing extrinsic coronary compression

Ricardo Ribeiro Dias et al. Flávio Duarte Camurça Osanan Amorim Leite Filho Noedir Antônio Groppo Stolf

Sinus of Valsalva aneurysm is a rare cardiac disorder. It is more frequently a congenital, but it may also be an acquired condition. Takayasu’s disease is an extremely rare cause of this disorder. Most cases of unruptured sinus of Valsalva aneurysm are asymptomatic. Compression of the left coronary artery is an unusual manifestation of the disease that can cause angina, myocardial infarction or death. This report describes a 19-year-old black male with an unruptured right sinus of Valsalva aneurysm caused by Takayasu’s disease and manifested by an acute coronary syndrome, successfully treated by surgery.

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Case Report

Left atrial appendage aneurysm: echocardiografic diagnostic

Viviane Cordeiro Veiga et al. Salomón Soriano Ordinola Rojas Amilton Silva Junior Marcelo Luiz Patrício … Elias César Hauy Marum Henry Abensur

The left atrial appendage aneurysm is a rare condition that frequently manifests itself by heart arrhythmias or thromboembolism. We report the case of a patient with left atrial appendage aneurysm, diagnosed by echocardiography and submitted to surgical resection.

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Artigo Original

Prospective study of early and late morbidity and mortality in the abdominal aortic aneurysm surgical repair

Francine C. de Carvalho et al. Veridiana Porto Maggioli da Rocha Brito Elisângela Campaner Tribulatto Bonno van Bellen

OBJECTIVE: To prospectively assess early and late morbidity and mortality of patients undergoing elective surgical repair of abdominal infrarenal aortic aneurysms and to determine the independent predictors of cardiac events. METHODS: For 6 consecutive years, this study analyzed 130 patients, who underwent routine standardized preoperative assessment always with the same clinical, surgical, and anesthesia teams. RESULTS: In-hospital mortality was 3.1% (4 patients), and the major cause of death was mesenteric ischemia, which occurred in 3 patients. Forty-eight (37%) nonsurgical complications occurred as follows: 8.5% were cardiac complications and 28.5% were noncardiac complications. The most common complications were the pulmonary ones, which occurred in 14 (10.8%) patients. Survivals in the first, third, and sixth postoperative years were 95%, 87%, and 76%, respectively. The variables that significantly correlated with morbidity and mortality were clinical predictors, mean age of 70.5 years, and presence of heart failure and chronic renal failure. No predictor of late morbidity and mortality was identified. CONCLUSION: Although this is considered a highly complex surgery, mortality is low, the cardiac complications are not very significant, and the patients have a good long-term evolution.

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Original Article

Comparison between Adventitial and Intimal Inflammation of Ruptured and Nonruptured Atherosclerotic Plaques in Human Coronary Arteries

Maria L. Higuchi et al. Paulo S. Gutierrez Hiram G. Bezerra Suely A. Palomino … Vera D. Aiello Júlia M. L. Silvestre Peter Libby José A. F. Ramires

OBJECTIVE: To verify the possible role of adventitial inflammation in atherosclerotic plaque vulnerability and coronary artery remodelling. METHODS: We compared the mean numbers of lymphocytes in the adventitia and in the plaque of ruptured thrombosed and stable equi-stenotic coronary segments of 34 patients who died due to acute myocardial infarction. We also analysed adventitial microvessels, adventitial fibrosis and the external elastic membrane. RESULTS: In the adventitia, the numbers of lymphocytes and microvessels/mm² were 69.5±88.3 and 60.9± 32.1 in culprit lesions and 16.4 ± 21.1 and 44.3±16.1 in stable lesions (p<0.05); within the plaques, the mean number of lymphocytes was 24±40.8 in culprit lesions and 10.9±13.2 in stable ones (p=0.17). The mean percent area of adventitial fibrosis/cross-sectional area of the vessel was significantly lower in unstable plaques (p<0.001). The confocal images showed holes in the external elastic membrane. CONCLUSION: Unstable plaques exhibit chronic pan-arteritis, accompanied by enlargement, medial thinning, and less fibrosis than in stable lesions, which is compatible with vessel aneurysm. Adventitial inflammation may contribute significantly to atheroma instability.

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