2025/02/13 by Cuilin Zhu, Tonghua Du, Kexiang Liu · 1 voice
Medicine · #Cardiovascular Issues in Pregnancy #Coronary Artery Anomalies #Kawasaki Disease and Coronary Complications
paper · doi:10.1093/ehjci/jeaf008
openalex publication_date 2025/02/13 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
A 67-year-old woman was admitted of breath shortness and lower limb oedema. Her electrocardiogram showed atrial fibrillation (Panel A). Trans-thoracic echocardiography revealed severe mitral regurgitation and severe tricuspid regurgitation. A membrane (arrow, Panel B) and a 19-mm communicating hole (asterisk, Panel B) were detected inside the left atrium, dividing the left atrium into true chamber and accessory chamber (AC; see Supplementary data online, Video S1). Blood flow was observed across the whole (Panel C; see Supplementary data online, Videos S2 and S3). A diagnosis of cor triatriatum sinister (CTS) was made, with floating thrombosis (51 × 48 mm) shown inside the AC (Panel A). Due to the rare incidence of CTS in adults, further imaging tests were ordered. Coronary computed tomography angiography showed that the AC (160 × 98 × 112 mm) turned out to be an coronary artery aneurysm (CAA) independent of both atriums (Panels D and E), with blood flow originating from the left coronary artery (LCA) (arrow, Panel F; see Supplementary data online, Video S4). Cardiac magnetic resonance imaging further demonstrated vortex signalling inside the CAA with blood commination into the right atrium (asterisk, Panel G; see Supplementary data online, Video S5). Mural thrombosis was also detected inside the CAA (arrow, Panel H). Taken all the evidence together, the CTS diagnosis was denied. The diagnosis of giant CAA with intramural thrombosis, originating from LCA with fistula into the right atrium, severe mitral, and tricuspid regurgitation was made, which was also confirmed intra-operatively (Panel I). Closure of the fistula, resection of the CAA, valve plasties, and Cox-Maze IV procedure were successfully performed.