Acute myocardial infarction caused by coronary artery aneurysm in Behçet’s disease and review of the literature

Abstract

Behçet’s disease is a chronic relapsing disease with multiple organ system involvement characterized clinically by oral and genital aphthae, cutaneous lesions, and ophthalmological, neurological, and/or gastrointestinal manifestations. It is an autoimmune vasculitis with rare incidence of vascular involvement, and especially of coronary arteries. The case present in this paper has coronary artery aneurysm in associated with Behçet’s disease. Coronary angiography has revealed an aneurysm on the left anterior descending coronary artery of a 45-year old male patient who admitted our clinic with acute myocardial infarction. Successful coronary artery bypass grafting operation with left internal mammary artery to left anterior descending coronary artery (LAD) was performed after proximal and distal ligation of aneurysm.

Keywords

• Acute myocardial infarction
• Behçet’s disease
• Coronary aneurysm
• Coronary angiography

References

1. Barçın, C., İyisoy, A., Kursaklıoğlu, H., Demirtaş, E., 2004. A giant left main coronary artery aneurysm in a patient with Behcet`s disease. Anatol. J. Cardiol. 2, 193.
2. Cevik, C., Otahbachi, M., Nugent, K., 2009. Coronary artery aneurysms in Behçet’s disease. Cardiovasc. Revasc. Med. 10, 128-129. doi: 1016/j.carrev.2008.01.001.
3. Cook, A.L., Rouster-Stevens, K., Williams, D.A., Hines, M.H., 2010. Giant aneurysm of the left anterior descending coronary artery in a pediatric patient with Behcet’s disease. Pediatr. Cardiol. 31, 700-702. doi: 10.1007/s00246-009-9636-6.
4. Cuisset, T., Quilici, J., Bonnet, J.L., 2007. Giant coronary artery aneurysm in Behcet’s disease. Heart. 93, 1375. doi: 10.1136/hrt.2006.104893 Doğan, A., Çelik, A., Doğan, S., Ozdoğru, I., 2011. Case images Acute myocardial infarction due to a large coronary aneurysm in Behçet’s disease. Arch. Turk. Soc. Cardiol. 39, 737. doi: 10.5543/tkda.2011.01639.
5. Dogan, S.M., Aydin, M., Gursurer, M. Onuk T., 2006. A giant aneurysm of the left main coronary artery in a patient with Behçet’s disease. Tex. Heart. Inst. J. 33, 269.
6. Ebina, T., Ishikawa, Y., Uchida, K., Suzuki, S., Imoto, K., Okuda, J., Tsukahara, K., Hibi, K., Kosuge, M., Sumita, S., Mochida, Y., Ishikawa, T., Uchino, K., Umemura, S., Kimura, K., 2009. A case of giant coronary artery aneurysm and literature review. J. Cardiol. 53, 293-300. doi: 1016/j.jjcc.2008.07.015.
7. Geyik, B., Ozdemir, O., Ozeke, O., Duru, E., 2005. Giant left anterior descending artery aneurysm in a patient with Behcet’s disease. Heart lung and circulation. 14, 262. doi: 10.1016/j.hlc.2005.03.009.
8. Greenhouse, D.G., Hackett, K., Kahn, P., Balsam, L.B., Galloway, A.C., 2011. Giant coronary artery aneurysm in a patient with Behçet’s disease. J. Card. Surg. 26, 268-270. doi: 10.1111/j.1540-8191.2011.01223.x.

9. Kasapis, C., Grossman, P.M., Chetcuti, S.J., 2009. Cardiovascular flashlight. Percutaneous treatment of a giant right coronaryartery pseudoaneurysm in Adamantiades-Behcet’s syndrome. Eur. Heart J. 30, 2630. doi: 10.1093/eurheartj/ehp340.
10. Matsumoto, T., Uekusa, T., Fukuda, Y., 1991. Vasculo-Behc¸et’s disease: A pathologic study of eight cases. Hum. Pathol. 22, 45-51.
11. Okutucu, S., Karakulak, U.N., Kalyoncu, U., Aydemir, K., 2011. Cerebral and coronary artery aneurysms in a patient with Behçet’s disease. Anadolu Kardiyol. Derg. E-page Original Images. 11, 31-34. doi: 10.5152/akd.2011.208.
12. Ozeren, M., Dogan, O.V., Dogan, S., Yucel E., 2004. True and pseudo aneurysms of coronary arteries in a patient with Behçet’s disease. Eur. J. Cardiothorac. Surg. 25, 465-467. doi: 10.1016/j.ejcts.2003.11.040.
13. Porcu, P., Chavanon, O., Bertrand, B., Costache, V., Carley, H., Bach, V., Hacini, R., Blin, D., 2008. Giant aneurysm of the proximal segment of the left anterior descending artery in a patient with Behçet’s disease-a combined approach. Can. J. Cardiol. 24, 73-74.
14. Spiliotopoulos, K., Yanagawa, B., Crean, A., Overgaard, C., Brister, S.J., 2011. Surgical management of a left anterior descending pseudoaneurysm related to Behcet’s disease. Ann. Thorac. Surg. 91, 912-914. doi: 10.1016/j.athoracsur.2010.08.066.
15. Syed, M., Lesch, M., 1997. Coronary artery aneurysm: A review. Progress in cardiovascular. Diseases. 40, 77-84. doi: 10.1016/S00330620(97)80024-2.
16. Yildiz, A., Arslan, C., Erol, C., 2012. Cardiac tamponade due to rupture of a right coronary artery aneurysm in a patient with Behçet’s disease. J. Cardiovasc. Med. (Hagerstown). 13, 343-345. doi: 10.2459/JCM.0b013e328338933b. Soylu et al.
17. LAD (Table 1). The most frequent symptom is chest pain. In the literature, apart from ours, only one other case report with ST elevated MI has been encountered (Doğan et al., 2011).
18. However, one case with MI without ST elevation (Cuisset et al., 2007), one case with unstable angina (Porcu et al., 2008) and one case with stable angina pectoris (Cevik et al., 2009) have been diagnosed.
19. In our case we have encountered a history of surgical treatment of popliteal artery aneurysm four years previously. There have been very few earlier reports on coronary artery aneurysms together with aneurysms at other locations. One case has been reported with cerebral artery aneurysm, and one with femoral artery aneurysm (Ozeren et al., 2004; Okutucu et al., 2011).
20. In the literature, conservative approach is the most frequently used option for CAAs. Surgical treatment was recommended in cases with ischemia or high rupture risk. Only Kasapis et al. have successfully treated an aneurysm on the right coronary artery (RCA) with a 3.0x26 mm coated coronary stent. Although a similar approach was considered in our case the length of the aneurysm did not allow for this, therefore, surgical treatment had to be performed. In conclusion, CCA’s in association with Behçet’s disease are very rare. Presence or the history of other aneurysms in these patients could be a warning criterion for coronary artery involvement. Although there have not been enough numbers of cases to recommend the mode of therapy, the conservative approach may be suitable in the asymptomatic cases.