Baylor University Medical Center Proceedings July 2017 - 303

Coronary arterial aneurysms in previously transplanted
(donor) hearts
Nitin Kondapalli, MBBS, and William C. Roberts, MD

Described herein is a 57-year-old man who had had a cardiac transplant 5 years earlier (at age 52) and died of a ruptured abdominal aortic
aneurysm. The donor heart was found to have a fusiform aneurysm, each
filled with thrombus, in 2 major epicardial coronary arteries.

he occurrence of aneurysm involving the aorta is fairly
common. In contrast, aneurysm involving one or more
epicardial coronary arteries is extremely uncommon. In
a 24-year period, Roberts (1) collected at necropsy the
native hearts of 20 adults who had large aneurysms of one or
more major epicardial coronary arteries. Those 20 cases were
found from examining approximately 12,000 hearts during that
time. Recently, we observed coronary aneurysms in a donor
heart that had been transplanted 5 years earlier. A description
of this unusual ﬁnding is the purpose of this report.
CASE STUDY
A 57-year-old white man who had had a heart transplant
at age 52 died suddenly from a ruptured abdominal aortic aneurysm. The transplanted heart contained huge quantities of
adipose tissue and ﬂoated in a container of formaldehyde. The
left anterior descending and ramus intermedius coronary arteries
each had a fusiform aneurysm ﬁlled with thrombus (Figure).
All of the major epicardial coronary arteries contained considerable quantities of atherosclerotic plaque that narrowed their
lumens. Despite this narrowing, there were no grossly visible
myocardial lesions, and neither ventricular cavity was dilated.
The heart weighed 570 grams and the patient's body mass index
was 36 kg/m2.
DISCUSSION
The cause of aneurysmal formation in epicardial coronary
arteries in native hearts is entirely unclear. The aneurysms in
this location, with rare exception, are fusiform and contain
thrombus superimposed on atherosclerotic plaque (1). Their
rarity in coronary arteries in contrast to their relative frequency
in the aorta may in part be related to their exposure to only a
systemic diastolic pressure rather than to a peak systolic pressure,
as occurs in the aorta. The aneurysms in native coronary arteries
are not the consequence of an underlying arteritis.
Proc (Bayl Univ Med Cent) 2017;30(3):303-304

Figure. Diagram showing the aneurysms in the left anterior descending and
ramus intermedius coronary arteries. Thrombus, shown in red, is present in each
aneurysm. A cross-section is also shown of each aneurysm demonstrating that
the thrombus does not involve all surfaces of the artery, thereby making the lumen
at the site of the aneurysm eccentric. The largest diameter of each aneurysm
was approximately 4 times that of the adjacent normal coronary artery. Heavy
atherosclerotic plaque was present diffusely in all epicardial coronary arteries.
LM indicates left main; R, right coronary artery.

The occurrence of aneurysm in one or more epicardial coronary arteries in donor hearts must be exceedingly uncommon.
We have encountered coronary aneurysm in only one of 79
donor hearts studied at necropsy. (The longest interval from
From the Baylor Heart and Vascular Institute and the Departments of Internal
Medicine (Cardiology) and Pathology, Baylor University Medical Center, Dallas,
Texas.
Corresponding author: William C. Roberts, MD, Baylor Heart and Vascular
Institute, 621 N. Hall Street, Suite H030, Dallas, TX 75226 (e-mail: william.
roberts1@bswhealth.org).
303

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings July 2017