APICTURE IS WORTH A THOUSAND WORDS

Fig. 1. A. Coronary arteriogram of LAD shows a proximal giant fusiform aneurysm of irregular shape (white arrows). The rest of the LAD is normal in caliber without discrete stenosis. B. Short saccular aneurysm of the circumflex artery is shown (yellow arrows) and a short, normal caliber LMCA (red arrows). The LAD aneurysm (white arrowheads) is again visualized. C. Injection in the vicinity of the RCA ostium shows multiple small vessels emerging from the coronary sinus filling the normal-sized RCA without discrete stenosis. D. Aortogram in the abdominal aorta revealed multiple aneurysms (black arrows) of both iliac arteries: one long fusiform aneurysm starting at the bifurcation and extending several centimeters in the left iliac artery and two aneurysms in the right iliac artery separated by approximately 1 cm of normal vessel. Abbreviations: LAD = left anterior descending; LMCA = left main coronary artery; RCA = right coronary artery.

Comment: The patient presented at 11 months of age with congestive heart failure. An electrocardiogram showed deep Q waves in leads II, III, and AVF indicating inferior myocardial infarction (MI). The echocardiogram showed a dilated, poorly contracting left ventricle and dilated left anterior descending coronary artery. Myocardial perfusion scintigraphy demonstrated a large perfusion defect in the inferior wall. The patient suffered from Kawasaki disease at the age seven months while in his country, Iraq. He did not receive appropriate therapy during the acute stage of his illness and he subsequently developed aneurysms of the coronary and iliac arteries. The inferior MI was due to thrombosis of the right coronary artery and the thrombus probably spontaneously recanalized later. The heart failure was controlled and he was discharged on warfarin, aspirin, digoxin, and lasix.

                                                      Andrej Robida, MD, FACC
                                                      Consultant PediatricCardiologist
                                                      Pediatric Cardiology Section
                                                      Cardiology and Cardiovascular Surgery Department
                                                      Hamad Medical Corporation (1989 _ 2001)
                                                      Undersecretary of Health, Slovenia (2002 _ present)