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An Unusual Treatment of Atrial Fibrillation
Journal of the American College of Cardiology © 2010 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 56, No. 15, 2010 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2009.09.086
IMAGES IN CARDIOLOGY
An Unusual Treatment of Atrial Fibrillation Percutaneous Exclusion of a Large Coronary Aneurysm Francesco Burzotta, MD, PHD,* Carlo Trani, MD,* Costantino Smaldone, MD,* Riccardo Marano, MD,† Giovanni Schiavoni, MD,* Filippo Crea, MD* Rome, Italy
From the *Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy; and the †Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy. Manuscript received September 8, 2009; accepted September 17, 2009.
A
69-year-old man was admitted to our institution for exertional dyspnea. The electrocardiogram (ECG) demonstrated atrial fibrillation (heart rate 88 beats/min). Transthoracic and, subsequently, transesophageal echocardiography showed the presence of a mass located close to the posterolateral wall of the left atrium (LA) with an echo-free content and an internal Doppler signal. The 64-slice computed tomography (CT) angiography displayed an aneurysm (maximum diameter 35 ⫻ 30 mm) of an LA branch of the left circumflex coronary artery (LCx), whose lumen was partially occluded due to thrombosis and demonstrated a compression of the posterolateral wall of the LA (near the pulmonary veins: A and B). Coronary angiography confirmed the presence of a large saccular aneurysmal cavity (arrow) of the LA branch of the LCx (C). We successfully sealed the aneurysm by using a polytetrafluoroethylene-covered stent (D, Online Video 1). The post-procedural course was uneventful, and at 3-month follow-up, an ECG and 24-h Holter monitoring showed a stable sinus rhythm, and CT angiography showed a patent stent and a persistent exclusion of the aneurysm.
Vol. 56, No. 15, 2010 ISSN 0735-1097/$36.00 doi:10.1016/j.jacc.2009.09.086
IMAGES IN CARDIOLOGY
An Unusual Treatment of Atrial Fibrillation Percutaneous Exclusion of a Large Coronary Aneurysm Francesco Burzotta, MD, PHD,* Carlo Trani, MD,* Costantino Smaldone, MD,* Riccardo Marano, MD,† Giovanni Schiavoni, MD,* Filippo Crea, MD* Rome, Italy
From the *Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy; and the †Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy. Manuscript received September 8, 2009; accepted September 17, 2009.
A
69-year-old man was admitted to our institution for exertional dyspnea. The electrocardiogram (ECG) demonstrated atrial fibrillation (heart rate 88 beats/min). Transthoracic and, subsequently, transesophageal echocardiography showed the presence of a mass located close to the posterolateral wall of the left atrium (LA) with an echo-free content and an internal Doppler signal. The 64-slice computed tomography (CT) angiography displayed an aneurysm (maximum diameter 35 ⫻ 30 mm) of an LA branch of the left circumflex coronary artery (LCx), whose lumen was partially occluded due to thrombosis and demonstrated a compression of the posterolateral wall of the LA (near the pulmonary veins: A and B). Coronary angiography confirmed the presence of a large saccular aneurysmal cavity (arrow) of the LA branch of the LCx (C). We successfully sealed the aneurysm by using a polytetrafluoroethylene-covered stent (D, Online Video 1). The post-procedural course was uneventful, and at 3-month follow-up, an ECG and 24-h Holter monitoring showed a stable sinus rhythm, and CT angiography showed a patent stent and a persistent exclusion of the aneurysm.