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Vol. 17. Núm. 3.
Páginas 130-140 (Mayo - Junio 2010)
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Vol. 17. Núm. 3.
Páginas 130-140 (Mayo - Junio 2010)
Open Access
Aneurisma del tronco principal de la arteria coronaria izquierda Descripción de un caso clínico y revisión de tema
Aneurysm of the main trunk of the left coronary artery Description of a clinical case and kiterature review
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3125
Julio C. Rodríguez1,
Autor para correspondencia
julliusc@yahoo.com.mx

Correspondencia: Fundación Santa Fe de Bogotá. Departamento de Medicina Interna. Calle 119 No. 7-75. Bogotá DC., Colombia. Teléfonos: (571) 603 0303 Fax: (571) 6575714, AA. 220246.
, Alex Rivera1, Bibiana Pinzón1
1 Fundación Santa Fe de Bogotá, Bogotá, Colombia
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El aneurisma arterial coronario constituye una entidad rara en la población; su incidencia varía entre 1,5% y 5%, siendo más frecuente en hombres. Existe escasa bibliografía acerca de esta patología a pesar de que su estudio se remonta a finales del siglo XVIII. La arteria que se afecta con mayor frecuencia es la coronaria derecha, aproximadamente en 40% de los casos. La dificultad al momento del diagnóstico clínico radica en que inicialmente el enfoque está dirigido a confirmar y tratar de manera oportuna el síndrome coronario agudo que con insistencia constituye la manifestación inicial con que cursan este tipo de pacientes; por ello el diagnóstico necesariamente requiere ayudas imaginológicas e intervencionistas, o ambas. Hay muchas causas que puedan producir aneurismas en la circulación coronaria, la más común de ellas es la aterosclerosisseguida por trastornos congénitos, enfermedades del tejido conectivo, vasculitis y consumo de cocaína entre otros. Recientemente se han publicado innovadores estudios respecto a la fisiopatología y los avances en terapéutica farmacológica e intervencionista, aunque el tratamiento debe enfocarse en los factores de riesgo, las patologías y las manifestaciones clínicas que presente el paciente.

Palabras clave:
aneurisma arterial coronario
aneurisma sacular
aneurisma fusiforme
ectasia coronaria
isquemia miocárdica
cocaína
enfermedad de Kawasaki
síndrome coronario agudo
arterioesclerosis

Coronary artery aneurysm is a rare entity in the population. Its incidence rates vary between 1.5% - 5%, and is more frequent in males. There is limited literature on this disease, although its study goes back to the late eighteenth century. The most frequently affected artery is the right coronary artery, in approximately 40% of cases. The initial diagnostic difficulty lies in the fact that the initial approach is focused in confirming and treating properly the coronary acute syndrome, which is the most frequent initial presentation in these patients. Therefore, its diagnosis requires necessarily imaging or interventionist aid, or both. Many causes account for coronary aneurysms, being the most common atherosclerosis followed by congenital abnormalities, connective tissue diseases, vasculitis and cocaine consumption. Novel studies regarding the physiopathology and advances in pharmacological and interventionist therapy have been published, although treatment must focus on risk factors, associated pathologies and clinical manifestations.

Key words:
coronary artery aneurysm
sacular aneurysm
fusiform aneurysm
coronary ectasia
myocardial ischemia
cocaine
Kawasaki disease
acute coronary syndrome
atherosclerosis
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Bibliografía
[1.]
L. Nichols, S. Lagana, A. Parwani.
Coronary artery aneurysm a review and hypothesis regarding etiology.
Arch Pathol Lab Med, 132 (2008), pp. 823-828
[2.]
M. Syed, M. Lesch.
Coronary artery aneurysm: a review.
Progress in Cardiovascular Diseases, 40 (1997), pp. 77-84
[3.]
J.E. Markis, C.D. Joffe, P.F. Cohn.
Clinical significance of coronary arterial ectasia.
Am J Cardiol, 37 (1976), pp. 217-222
[4.]
J.B. Morgagni.
De sedibus et causis morborum.
Venectus Tom I, Epis 27, Art 28, (1761),
[5.]
T.M. Munker, O. Peterson, J. Vesterdal.
Congenital aneurysm of the coronary artery with an arteriovenous fistula.
Acta Radiol, 50 (1958), pp. 333-336
[6.]
S.N. Sharma, U. Kaul, S. Sharma, et al.
Coronary arteriographic profile in young and old Indian patients with ischemic heart disease: a comparation study.
Indian Heart J, 42 (1990), pp. 365-369
[7.]
P.S. Swaye, L.D. Fisher, P. Litwin, et al.
Aneurysmal coronary artery disease.
Circulation, 67 (1983), pp. 134-138
[8.]
T. Robertson, L. Fisher.
Prognostic significance of coronary artery aneurysm and ectasia in the coronary artery surgery study (CASS) registry.
Kawasaki disease: proceedings of the Second International Kawasaki Symposium, pp. 325-339
[9.]
P.A. Tunick, J. Slater, I. Kronzon, et al.
Discrete atherosclerotic coronary artery aneurysms: a study of 20 patients.
J Am Coll Cardiol, 15 (1990), pp. 279-282
[10.]
G.G. Hartnell, B.M. Parnell, R.B. Pride.
Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients.
Br Heart J, 54 (1985), pp. 392-395
[11.]
J.E. Markis, C.D. Joffe, P.F. Cohn.
Clinical significance of coronary arterial ectasia.
Am J Cardiol, 37 (1976), pp. 217-222
[12.]
A. Aintablian, R.I. Hamby, I. Hoffman, et al.
Coronary ectasia: incidence and results of coronary bypass surgery.
Am Heart J, 96 (1978), pp. 309-315
[13.]
R.A. Oliveros, H.L. Falsetti, R.J. Carroll, et al.
Atherosclerotic coronary artery aneurysm.
Arch intern Med, 134 (1974), pp. 1072-1080
[14.]
H.A. Berkoff, G.G. Rowe.
Atherosclerotic ulcerative disease and associated aneurysms of the coronary arteries.
Am Heart J, 90 (1975), pp. 153-158
[15.]
B. Befeler, J.M. Aranda, A. Embi, et al.
Coronary artery aneurysms: study of their etiology, clinical course and effect on left ventricular function and prognosis.
Am J Med, 62 (1977), pp. 597-607
[16.]
S. Rath, Y. Har-Zahav, A.E. Battler, et al.
Fate of non-obstructive aneurysmatic coronary artery disease: Angiographic and clinical follow-up report.
Am Heart J, 109 (1985), pp. 785-791
[17.]
H.R. Swanton, M.L. Thomas, D.J. Coltart, et al.
Coronary artery ectasia, a variant of occlusive coronary arteriosclerosis.
British Heart J, 40 (1978), pp. 393-400
[18.]
H.L. Falsetti, R.J. Carroll.
Coronary artery aneurysm. A review of the literature with a report of 11 new cases.
Chest, 69 (1976), pp. 630-636
[19.]
A. Daoud, D. Pankin, H. Tulgan, R. Florentin.
Aneurysms of the coronary artery. Report of ten cases and review of literature.
Am J Cardio, 111 (1963), pp. 228-237
[20.]
P. Cohen, P. O’Gara.
Coronary artery aneurysms: a review of the natural history, pathophysiology, and management.
Cardiol Rev, 16 (2008), pp. 301-304
[21.]
M. Syed, M. Lesch.
Coronary artery aneurysm: a review.
Prog Cardiovasc Dis, 40 (1997), pp. 77-84
[22.]
I. Aneta, Gziut, J. Robert, et al.
Coronary aneurysms.
Polskie Archiwum Medycyny Wewnetrznej, 118 (2008), pp. 741-745
[23.]
A. Daoud, D. Pankin, H. Tulgan, et al.
Aneurysms of the coronary artery. Report of ten cases and review of literature.
Am J Cardio, 111 (1963), pp. 228-237
[24.]
H.A. Berkoff, G.G. Rowe.
Atherosclerotic ulcerative disease and associated aneurysms of the coronary arteries.
Am Heart J, 90 (1975), pp. 153-158
[25.]
B. Befeler, J.M. Aranda, A. Embi, et al.
Coronary artery aneurysms: study of their etiology, clinical course and effect on left ventricular function and prognosis.
Am J Med, 62 (1977), pp. 597-607
[26.]
J.E. Markis, C.D. Joffe, P.F. Cohn.
Clinical significance of coronary arterial ectasia.
Am J Cardiol, 37 (1976), pp. 217-222
[27.]
J.F. England.
Herbicides and coronary artery ectasia.
Med J Aust, II (1981), pp. 140
[28.]
R.L. Lange, M.S. Reid, D.D. Tresch, et al.
Nonatheromatous ischemic heart disease following withdrawal from chronic industrial nitroglycerine exposure.
Circulation, 46 (1972), pp. 666-678
[29.]
N. Lamblin, C. Bauters, X. Hermant, et al.
Polymorphisms in the promoter regions of MMP-2, MMP-3, MMP-9, and MMP-12 genes as determinants of aneurismal coronary artery disease.
J Am Coll Cardiol, 40 (2002), pp. 43-48
[30.]
Y. Onouchi, T. Gunji, J.C. Burns, et al.
ITPKC functional polymorphism associated with Kawasaki disease susceptibility and formation of coronary artery aneurysms.
Nat Genet, 40 (2008), pp. 35-42
[31.]
H. Senzaki, S. Masutani, J. Kobayashi, et al.
Circulating matrix metalloproteinases and their inhibitors in patients with Kawasaki disease.
Circulation, 104 (2001), pp. 860-863
[32.]
H. Senzaki, S. Masutani, J. Kobayashi, et al.
Circulating matrix metalloproteinases and their inhibitors in patients with Kawasaki disease.
Circulation, 104 (2001), pp. 860-863
[33.]
G.W. Stone, S.G. Ellis, L. Cannon, et al.
Comparison of a polymer-based paclitaxeleluting stent with a bare metal stent in patients with complex coronary artery disease: a randomized controlled trial.
JAMA, 294 (2005), pp. 1215-1220
[34.]
B.D. Gelb.
Marfan's syndrome and related disorders: more tightly connected than we thought.
N Engl J Med, 355 (2006), pp. 841-844
[35.]
B.L. Loeys, U. Schwarze, T. Holm, et al.
Aneurysm syndromes caused by mutations in the TGF-beta receptor.
N Engl J Med, 355 (2006), pp. 788-798
[36.]
P.K. Peterson, G. Gekker, C.C. Chao, et al.
Cocaine potentiates HIV-1 replication in human peripheral blood mononuclear cell cocultures: involvement of transforming growth factor-beta.
J Immunol, 146 (1991), pp. 81-84
[37.]
J.P. Habashi, D.P. Judge, T.M. Holm, et al.
Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome.
Science, 312 (2006), pp. 117-121
[38.]
Z. Luan, A.J. Chase, A.C. Newby.
Statins inhibit secretion of metalloproteinases 1, 2, 3, and 9 from vascular smooth muscle cells and macrophages.
Arterioscler Thromb Vasc Biol, 23 (2003), pp. 769-775
[39.]
I.A. Khan, O.M. Dogan, B.C. Vasavada, et al.
Nonatherosclerotic aneurysm of the left circumflex coronary artery presenting with accelerated angina pectoris: response to medical management: a case report.
Angiology, 51 (2000), pp. 595-598
[40.]
B. Lima, S.K. Varma, J.E. Lowe.
Nonsurgical management of left main coronary artery aneurysms.
Tex Heart Inst J, 33 (2006), pp. 376-379
[41.]
J.M. Schussler, W.H. Jones, R.C. Vallabhan.
Management of a single coronary artery aneurysm by use of a stent.
Proc (Bayl Univ Med Cent), 15 (2002), pp. 255-256
[42.]
D.J. Kereiakes, D.E. Long, T.D. Ivey.
Coil embolization of a circumflex coronary aneurysm at the time of percutaneous coronary stenting.
Cathet Cardiovasc Intervent, 67 (2006), pp. 607-610
[43.]
I. Antonellis, S. Patsilianakos, C. Pamboukas.
Sealing of coronary artery aneurysm by using a new stent graft.
Catheter Cardiovasc Interv, 48 (1999), pp. 96-99
[44.]
I.N. Anabtawi, J.A. de Leon.
Coronary ectasia: incidence and results of coronary bypass surgery.
Am Heart J, 96 (1978), pp. 309-315
[45.]
P.A. Ebert, R.H. Peter, J.C. Gunnels.
Resecting and grafting of coronary artery aneurysm.
Circulation, 43 (1971), pp. 593-598
[46.]
W.J. Alford, W.S. Stoney, G.T. Burrus, et al.
Recognition and operative management of patients with arteriosclerotic coronary artery aneurysms.
Ann Thorac Surg, 22 (1976), pp. 317-321
[47.]
G. Mariscalco, V. Mantovani, S. Ferrarese, et al.
Coronary artery aneurysm: management and association with abdominal aortic aneurysm.
Cardiovasc Pathol, 15 (2006), pp. 100-104
[48.]
A. Daoud, D. Pankin, H. Tuigan, et al.
Aneurysms of the coronary artery. Report of ten cases and review of literature.
Am J Cardiol, 11 (1983), pp. 228-237
[49.]
S. Zoneraich, O. Zoneraich.
Giant coronary artery aneurysm. The case of middiastolic murmur and bulging of the left cardiac border.
JAMA, 231 (1975), pp. 179
[50.]
T.E. Cappanari, S.R. Daniels, R.A. Meyer, et al.
Sensitivity, specificity and predictive value of two-dimensional echocardiography in detecting coronary artery aneurysms in patients with Kawasaki disease.
J Am Coll Cardiol, 7 (1986), pp. 355-360
[51.]
A.L. Pucillo, A.G. Schechter, R.A. Moggio, et al.
MR imaging in the definition of coronary artery anomalies.
J Comput Assist Tomogr, 14 (1990), pp. 171-174
[52.]
Jumbo Ge, F. Liu, P. Kearney, et al.
Intravascular ultrasound approach to the diagnosis of coronary artery aneurysms.
Am Heart J, 130 (1995),
[53.]
P.S. Swaye, L.D. Fisher, P. Litwin, et al.
Aneurysmal coronary artery disease.
Circulation, 67 (1983), pp. 134-138
[54.]
A. Maseri, A. Pesola, M. Marzilli, et al.
Coronary vasospasm in angina pectoris.
Lancet, 1 (1977), pp. 713-717
[55.]
S.B. Freedman, D.R. Richmond, D.T. Kelly.
Clinical studies of patients with coronary spasm.
Am J Cardiol, 52 (1983), pp. 67A-71A
[56.]
A.A. Bove, R.E. Vlietstra.
Spasm in ectatic coronary arteries.
Mayo Clin Proc, 60 (1985), pp. 822-826
[57.]
T. Gutowski, A.K. Tannenbaum, A.E. Moreyra.
Vasospasm in a coronary artery aneurysm.
Cathet Cardiovas Diagn, 22 (1991), pp. 127-129
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