Acute coronary syndrome in a young woman with a giant coronary aneurysm and mitral valve prolapse: a case report and literature review

Abstract

Acute coronary syndrome in the young population is infrequently seen and has a different etiology from that in the elderly population. Giant coronary artery aneurysms are rare and usually asymptomatic, but they can cause acute clinical symptoms such as chest pain or chest tightness. We herein describe a young woman with a history of mitral valve prolapse who developed sudden-onset chest pain. She had mild elevations of her creatine kinase and cardiac troponin levels; however, no ST segment alteration was found on an electrocardiogram, and no abnormal regional wall movement was noted on echocardiography. Cardiac magnetic resonance imaging with late gadolinium enhancement revealed a "mass" at the right coronary artery and linear subendocardial enhancement at the posterior wall. Coronary angiography later confirmed a giant coronary aneurysm with a substantial thrombus. The combined presence of the coronary artery aneurysm and mitral valve prolapse in this patient was likely a sequela of Kawasaki disease.

Keywords: Giant coronary aneurysm; Kawasaki disease; acute coronary syndrome; coronary angiography; mitral valve prolapse; thrombosis.

Figure 1.

Twelve-lead electrocardiogram in the emergency room. Sinus rhythm with heart rate of 88 beats per minute was observed. No ST-T change was found.

Figure 2.

Cardiac magnetic resonance imaging with late gadolinium enhancement. (a) A “mass” was found at the right coronary artery (thick white arrow). (b) Delayed gadolinium enhancement demonstrated linear subendocardial enhancement at the posterior wall of the left ventricle (thin white arrows).

Figure 3.

Coronary angiography results. Two projections were used to show the right coronary artery: (a) left anterior oblique 45º and (b) cranial 30º. The giant coronary artery aneurysm was located at the middle part of the right coronary artery (thick white arrows). A residual thrombus was found in the PDA (thin white arrow).