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Ann Thorac Surg 2009;87:351. doi:10.1016/j.athoracsur.2008.06.006
© 2009 The Society of Thoracic Surgeons
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Correspondence

Pericardial Patch on Coronary Aneurysm

Teruya Nakamura, MD

Division of Cardiovascular Surgery, National Hospital Organization, Kure Medical Center, 3-1 Aoyama-Cho, Kure, Hiroshima, 737-0023 Japan

(Email: teruyan{at}kure-nh.go.jp).

To the Editor:

I read with great interest the case report by Luthra and colleagues [1]. Coronary artery aneurysm formation developed in the patient 4 years after drug-eluting stent (DES) placement. We believe that this is the second report of coronary aneurysm as a complication by DES [2]. They applied an autologous pericardial patch and BioGlue (CryoLife Inc, Kennesaw, GA) onto the aneurysm to prevent potential rupture, and coronary artery bypass was performed.

There is no consensus of the treatment of choice for coronary aneurysm. Because of the low incidence of rupture, conservative management is frequently chosen [3, 4]. Coronary artery bypass seems appropriate if there is an evidence of concomitant atherosclerosis and myocardial ischemia. Sometimes angioplasty or ligation/oversewing of the aneurysm are performed due to the risk of thromboembolism [3, 4]. The way in which the authors treated the aneurysm would be an interesting option, where the risk of rupture was extremely high. Its benefit over ligation of the aneurysm is to avoid disruption of the native coronary flow (eg, the septal branches), whereas the patch "enforces" it outside. However, we need more information on usefulness of the patch enforcement and some evidence of preventing rupture. Another concern is that the patch enforcement leaves the potential source of coronary thromboembolism, which is believed to be more prevalent than rupture [3, 4]. As the authors pointed out, DES causes inflammation, weakening, and erosion on the local vessel wall, thereby predisposing it to thrombus formation and subsequent distal embolization [5]. Why did the authors make a decision to treat the aneurysm by the patch enforcement, but not ligation of the aneurysm? What is the outcome of the operation if this option is their routine to treat coronary aneurysm? Again, I congratulate them for the great presentation.


   References
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 References
 

  1. Luthra S, Tatoulis J, Warren RJ. Drug-eluting stent-induced left anterior descending coronary artery aneurysm: repair by pericardial patch—where are we headed? Ann Thorac Surg 2007;83:1530-1532.[Abstract/Free Full Text]
  2. Singh H, Singh C, Aggarwal N, Dugal JS, Kumar A, Luthra M. Mycotic aneurysm of left anterior descending artery after sirolimus-eluting stent implantation: a case report Catheter Cardiovasc Interv 2005;65:282-285.[Medline]
  3. Ercan E, Tengiz I, Yakut N, Gurbuz A. Large atherosclerotic left main coronary aneurysm: a case report and review of literature Int J Cardiol 2003;88:95-98.[Medline]
  4. Everett JE, Burkhart HM. Coronary artery aneurysm: case report J Cardiothorac Surg 2008;3:1.[Medline]
  5. Melikian N, Wijns W. Drug-eluting stents: a critique Heart 2008;94:145-152.[Abstract/Free Full Text]

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Suvitesh Luthra and James Tatoulis
Ann. Thorac. Surg. 2009 87: 351-352. [Extract] [Full Text] [PDF]



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S. Luthra and J. Tatoulis
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Ann. Thorac. Surg., January 1, 2009; 87(1): 351 - 352.
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