Rapid progression of a coronary artery aneurysm caused by IgG4-related disease

IF 2.3 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Pathology Pub Date : 2024-04-20 DOI:10.1016/j.carpath.2024.107647

Yohei Miura , Kohei Koyama , Takashi Kohno , Kyoko Soejima , Sho Torii , Gaku Nakazawa

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引用次数: 0

Abstract

Background

IgG4-related disease (IgG4-RD) is a recently recognized fibro-inflammatory disorder that can affect almost any organ. IgG4-RD has also been reported in coronary arteries as periarteritis. IgG4-related coronary periarteritis may cause coronary artery aneurysms, and IgG4-related coronary artery aneurysms (IGCAs) are life-threatening. We describe a case of a patient with IGCA that highlights the usefulness and limitations of various IGCA evaluation modalities and provides insight into disease pathophysiology.

Case summary

A 60-year-old man with IgG4-RD diagnosed 2 years before and with IGCA at the proximal right coronary artery (RCA) on coronary angiography (CAG) 9 months prior to admission to the hospital presented with acute coronary syndrome. Emergent CAG revealed the rapid progression of IGCA at the RCA, an obstruction of the diagonal branch, and stenosis of the left anterior descending artery (LAD) and the high lateral branch (HL). The patient underwent percutaneous coronary intervention for the diagonal branch. The RCA aneurysm was resected and bypassed with a saphenous vein graft (SVG); coronary bypass grafting (left internal mammary artery to LAD and SVG to HL) was performed. Pathological findings showed inflammatory cell infiltration and disruption of the elastic plate.

Conclusion

IGCAs require careful follow-up with computed tomography scans for early detection of aneurysmal enlargement.

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由 IgG4 相关疾病引起的冠状动脉动脉瘤迅速恶化。

背景IgG4相关疾病（IgG4-RD）是一种新近被确认的纤维炎症性疾病，几乎可影响任何器官。据报道，IgG4-RD 在冠状动脉中也表现为动脉周围炎。IgG4 相关冠状动脉周围炎可能会导致冠状动脉瘤，而 IgG4 相关冠状动脉瘤（IGCA）可危及生命。我们描述了一例 IGCA 患者的病例，该病例强调了各种 IGCA 评估方法的有用性和局限性，并提供了对疾病病理生理学的见解。病例摘要一名 60 岁的男性患者在 2 年前诊断为 IgG4-RD，入院前 9 个月在冠状动脉造影（CAG）中发现右冠状动脉近端（RCA）有 IGCA，并伴有急性冠状动脉综合征。急诊冠状动脉造影（CAG）显示，RCA 的 IGCA 快速发展，对角支阻塞，左前降支（LAD）和高侧支（HL）狭窄。患者接受了经皮冠状动脉介入治疗对角支。切除了 RCA 动脉瘤，并用大隐静脉（SVG）进行了旁路移植；进行了冠状动脉旁路移植（左侧乳内动脉至 LAD，SVG 至 HL）。病理结果显示有炎症细胞浸润和弹力板破坏。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Pathology 医学-病理学

CiteScore

7.50

自引率

2.70%

发文量

审稿时长

18 days

期刊介绍： Cardiovascular Pathology is a bimonthly journal that presents articles on topics covering the entire spectrum of cardiovascular disease. The Journal''s primary objective is to publish papers on disease-oriented morphology and pathogenesis from clinicians and scientists in the cardiovascular field. Subjects covered include cardiovascular biology, prosthetic devices, molecular biology and experimental models of cardiovascular disease.