Clinical Images

Young Athlete With Complex Aneurysmal Coronary Stenosis

Eric P. Stahl, MD1;  Farshad Forouzandeh, MD, PhD2;  Brent P. Little, MD3;  Habib Samady, MD2

Eric P. Stahl, MD1;  Farshad Forouzandeh, MD, PhD2;  Brent P. Little, MD3;  Habib Samady, MD2

J INVASIVE CARDIOL 2017;29(12):E197-E198.

Key words: Kawasaki disease, coronary artery aneurysm

A 14-year-old male presented to our institution after a syncopal event while participating in football practice. On work-up, he was found to have an elevated troponin to 1.4 and ischemic ST-T changes on electrocardiogram. Cardiac magnetic resonance imaging showed a small inferior late gadolinium enhancement. He then had a cardiac computed tomography angiography, which demonstrated a proximal left anterior descending (LAD) occlusion at the bifurcation of the first diagonal (Figures 1A-1D). The proximal segment of the right coronary artery (RCA) was tortuous and aneurysmal. Left heart catheterization (Figures 1E-1G) was performed, and redemonstrated the 100% mid-LAD occlusion. He had right-to-left septal collaterals and left-to-left collaterals. There was also a 100% proximal left circumflex occlusion with a subsequent aneurysmal segment. The RCA had a beaded aneurysmal and curvy appearance. Kawasaki disease was suspected given the patient’s age and the presence of aneurysmal segments. A multiteam approach involving the adult congenital heart disease, cardiothoracic surgery, and interventional cardiology teams was required to determine the most appropriate management. The presence of multiple long segments of stenosis and complex aneurysms made percutaneous coronary intervention less favorable. The patient underwent coronary artery bypass graft with right internal mammary artery (IMA) graft to the mid obtuse marginal and the left IMA graft to the LAD. At 1-month follow-up, the patient remained asymptomatic. 

Kawasaki disease is an acute vasculitis that occurs predominantly in infants and children younger than 5 years old. If undiagnosed and untreated, the risk of developing coronary artery aneurysms increases to about 20%. In patients who present with angina and are found to have coronary artery aneurysm on imaging and angiography, Kawasaki disease should be considered as one of the leading diagnoses.

From 1the Department of Internal Medicine, 2Division of Cardiology, and 3Department of Radiology, Emory University School of Medicine, Atlanta, Georgia.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted May 10, 2017.

Address for correspondence: Eric Stahl, MD, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Atlanta, GA 30303. Email: