BACKGROUND Coronary artery aneurysms (CAAs), coronary arteriovenous malformations (CAVMs), and spontaneous
coronary artery dissections (SCADs) are rare clinical entities, and much is unknown about their natural history, prognosis,
and management.
METHODS A systematic search of MEDLINE, Embase, and Cochrane Library databases was performed in March 2023
to identify published papers related to CAAs, CAVMs, and SCADs.
RESULTS CAAs are found in 0.3% to 12% of patients undergoing angiography and are often associated with coronary
atherosclerosis. They are usually asymptomatic but can be complicated by thrombosis in up to 4.8% of patients and
rarely by rupture (0.2%). CAAs can be managed medically, percutaneously with stents or coil embolization, and surgically.
The most common surgical procedure is ligation of the aneurysm, followed by coronary artery bypass grafting.
The incidence of CAVMs is 0.1% to 0.2% in patients undergoing angiography, and they are most likely associated with
congenital abnormal development of the coronary vessels. The diagnosis of CAVMs is usually incidental. Surgical or
percutaneous intervention is indicated for patients with large CAVMs, which carry a potential risk of myocardial infarction.
SCADs represent 1% to 4% of all acute coronary syndromes and typically affect young women. SCADs are strongly
correlated with pregnancy, suggesting the role of sex hormones in their pathogenesis. Conservative management of SCAD
is preferred for stable patients without signs of ischemia as spontaneous resolution is frequently reported. Unstable patients
should undergo revascularization either percutaneously or with coronary artery bypass grafting.
CONCLUSIONS Further evidence regarding the management of these rare diseases is needed and can ideally be
derived from multicenter collaborations.
The Supplemental Material can be viewed in the online version of this
article [https://doi.org/10.1016/j.athoracsur.2023.11.033] on http://
www.annalsthoracicsurgery.org.
Bir yanıt yazın