Articles Tập 67 Số CĐ16 02/11/2026

PHÌNH ĐỘNG MẠCH VÀNH TẠI ĐIỂM PHÂN BA THÂN CHUNG ĐỘNG MẠCH VÀNH TRÁI: BÁO CÁO CA LÂM SÀNG

Nguyen Phuong Thao, Pham Manh Chung, Trinh Van Dong, Pham Van Tung, Dinh Hong Thanh, Phan Le Kim Chi
DOI: 10.52163/yhc.v67iCD16.6942
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Abstract

Background: Coronary artery aneurysm is a rare clinical entity, often incidentally detected during coronary angiography. In elderly patients, pathogenesis is primarily linked to chronic atherosclerosis, which leads to the destruction of the tunica media and maladaptive arterial remodeling.

Case presentation: A 70-year-old man with a medical history of hypertension and dyslipidemia presented with a 1-week history of exertional left-sided chest pain radiating to the neck, which was relieved by rest. On admission, electrocardiography showed no significant ST-segment or T-wave changes. High-sensitivity cardiac troponin T (hs-cTnT; upper reference limit, 14 ng/L) was not elevated at either 0 or 3 hours, with levels of 7 and 7.62 ng/L, respectively. Transthoracic echocardiography revealed no regional wall-motion abnormalities.

Coronary computed tomography angiography (CCTA) showed a localized fusiform aneurysm of the distal left main coronary artery (LMCA), measuring 16 mm in length and 9 mm in maximal diameter, at the trifurcation into the left anterior descending artery (LAD), left circumflex artery (LCx), and ramus intermedius. The Agatston coronary artery calcium score was 315. In addition, a 45% atherosclerotic stenosis was identified in the first diagonal branch (D1).

Management: The patient was diagnosed with stable angina associated with a coronary artery aneurysm, most likely of atherosclerotic etiology. He was managed with optimal medical therapy for symptom control, along with strict blood pressure and lipid management, targeting an LDL-cholesterol level of <1.8 mmol/L. After 28 months of follow-up, the size of the coronary aneurysm remained stable, with good control of anginal symptoms, blood pressure, and lipid levels. No acute cardiovascular events were documented during the follow-up period.

Conclusion: This case suggests that, in patients with a fusiform coronary artery aneurysm presenting with stable clinical symptoms, optimal medical therapy combined with regular imaging surveillance may be considered to control cardiovascular risk factors and monitor the stability of the aneurysmal vessel.

Keywords
Stable angina, Fusiform coronary artery aneurysm, Optimal medical therapy.
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