What Should Be Done if There Is Coronary Artery Disorder in Ruptured Abdominal Aortic Aneurysm?

Erdal Simsek, Mehmet Bayraktaroglu, Huseyin Bayram, Sevket Atasoy, Salih Fehmi Katircioglu

.

DOI: 10.4236/wjcs.2011.11001                

Abstract

Abdominal aortic aneurysm (AAA) is the most common type of aneurismal diseases. Generally, it is asymptomatic and when it is ruptured, it develops with high morbidity and mortality. Case report: A 62-years-old male patient consulted our emergency with a pain at his dorsum and lumbar part. Cardiologist with a suspicion of coronary artery disorder or dissection, coronary angiography was executed. Consecutive lesions of LAD artery (left anterior descending) 40% - 50% and 90%, CX artery (circumflex) 40% and 80% - 90%, and a lesion of RCA (right coronary artery) 20% - 30% were detected. With a suspicion of rupture, abdominal aneurysm tomography (CT) was demanded. In the tomography, a 7-cm-diameter ruptured abdominal aortic aneurysm was diagnosed. Levosimendan support was started. Under the support of levosimendan a Y graft operation was performed. The operation was ended up with levosimendan support considering that coronary bypass would increase mortality and morbidity. Discussion: Approximately 50% of the ruptured aneurysms are died before they reach hospital while the 30% - 70% operated ones are died within 30 days after operation. Early diagnosis and follow-up is extremely important to decrease morbidity and mortality. The patients consulting with rupture must be taken to the operation without delay. What should be done if coronary artery disorder is detected in the patient whose AAA is ruptured and if the bypass is necessary? In our opinion, a decision must be made according to the patient’s clinical condition. As a result of our case, we thought repairing the abdominal aortic aneurysm necessitates the other comorbidites must be treated medically. We aimed to decrease the cardiac oxygen requirement by starting levosimendan and decline afterload. If the patient, whose coronary artery disorder is detected, is under risk and his overall condition is bad, we think that coronary bypass operation can be delayed.

Keywords

Abdominal Aortic Aneurysm, Coronary Artery Disease, Levosimendan

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	S. H. Forshdahl, K. Singh, S. Solberg and B. K. Jacobsen, “Risk Factors for Abdominal Aortic Aneurysms a 7-Year Prospective Study: The Tromso Study, 1994-2001,” Circulation, Vol. 119, 2009, pp. 2202-2208. doi:10.1161/CIRCULATIONAHA.108.817619
[2]	K. Singh, K. H. Bonaa, B. K. Jacobsen, L. Bjork and S. Solberg, “Prevalence of and Risk Factors for Abdominal Aortic Aneurysms in a Population—Based Study: The Tromso Study,” American Journal of Epidemiology, Vol. 154, No. 3, 2001, pp. 236-244. doi:10.1093/aje/154.3.236
[3]	D. Reed, C. Reed, G. Stemmermann and T. Hayashi, “Are Aort?c Aneurysms Caused by Atherosclerosis?” Circulation, Vol. 85, 1992, pp. 205-211.
[4]	A. J. Lee, F. G. Fowkes, M. N. Carson, G. C. Leng and P. L. Allan, “Smoking, Atherosclerosis and Risk of Abdominal Aortic Aneurysm,” European Heart Journal, Vol. 18, No. 4, 1997, pp. 671-676.
[5]	S. Giordano, F. Biancari, P. Loponen, J. Wistbacka and M. Luther, “Preoperative Haemodynamic Parameters and the Immediate Outcome after Open Repair of Ruptured Abdominal Aortic Aneurysms,” Interactive Cardiovascular Thoracic Surgery, Vol. 9, 2009, pp. 491-493.
[6]	T. Wolff, D. Baykut, H. R. Zerkowski, P. Stierli and L. Gurke, “Combined Abdominal Aortic Aneurysm Repair and Coronary Artery Bypass: Presentation of 13 Cases and Review of the Literature,” Annals of Vascular Surgery, Vol. 20, No. 1, 2006, pp. 23-29. doi:10.1007/s10016-005-9324-9
[7]	I. Kantonen, M. Lepantalo, J. P. Salenius, S. Matzke, M. Luther and K. Ylonen, “Mortality in Abdominal Aortic Aneurysm Surgery: The Effect of Hospital Volume, Patient Mix and Surgeon’s Case Load,” European Journal of Vascular and Endovascular Surgery, Vol. 14, No. 5, 1997, pp. 375-379. doi:10.1016/S1078-5884(97)80287-0
[8]	T. Juvonen, F. Biancari, J. Rimpilainen, V. Anttila, M. Pokela, V. Vainionpaa, P. Romsi and K. Kiviluoma, “Determinants of Mortality after Hypothermic Circulatory Arrest in a Chronic Porcine Model,” European Journal of Cardio—Thoracic Surgery, Vol. 20, No. 4, 2001, pp. 803-810.
[9]	J. Levijoki, P. Pollesello, J. Kaivola, C. Tilgmann, T. Sorsa, A. Annila, I. Kilpelainen and H. Haikala, “Further Evidence for the Cardiac Troponin C Mediated Calcium Sensitization by Levosimendan. Structure—Response and Binding Analysis with Analogs of Levosimendan,” Journal of Molecular and Cellular Cardiology, Vol. 32, No. 3, 2000, pp. 479-491. doi:10.1006/jmcc.1999.1093
[10]	Z. Papp, K. Csapo, P. Pollesello, H. Haikala and I. Edes, “Pharmacological Mechanisms Contributing to the Clinical Efficacy of Levosimendan,” Cardiovasc Drug Review, Vol. 23, No. 1, 2005, pp. 71-98. doi:10.1111/j.1527-3466.2005.tb00158.x
[11]	D. P. Figgit, P. S. Gillies and K. L. Goa, “Levosimendan,” Drugs, Vol. 61, 2001, pp. 613-627. doi:10.2165/00003495-200161050-00006
[12]	M. Bayram, L. De Luca, B. M. Massie and M. Gheorghiade, “Dobutamine Milrinone and Dopamine in Acute Heart Failure Syndromes: A Reassessment,” American Journal of Cardiology, Vol. 96, No. 6, 2005, pp. 47-58. doi:10.1016/j.amjcard.2005.07.021
[13]	L. D. Caldicott, K. Hawley, R. Heppel, P. A. Woodmansey and K. S. Channer, “Intravenous Enoximone or Dobutamine for Severe Heart Failure after Acute Miyocardial Infarction: A Randomized Double-Blind Trial,” European Heart Journal, Vol. 14, No. 5, 1993, pp. 696-700. doi:10.1093/eurheartj/14.5.696
[14]	A. D. Michaels, B. McKeown, M. Kostal, K. T. Vakharia, M. V. Jordan, I. L. Gerber, E. Foster and K. Chatterjee, “Effects of Intravenous Levosimendan on Human Coronary Vasomotor Regulation, Left Ventricular Wall Stress, and Myocardial Oxygen Uptake,” Circulation, Vol. 111, 2005, pp. 1504-1509. doi:10.1161/01.CIR.0000159252.82444.22