Coronary Artery Aneurysm with Fistula Associated with Tricuspid Valve Regurgitation.

ABSTRACT: Aneurysmal dilation of coronary arteries is a rare condition detected during coronary angiography. Due to their poorly elucidated underlying mechanisms, their variable presentations, and the lack of large-scale outcome data on their various treatment modalities, coronary artery aneurysms, and coronary ectasia pose a challenge to the managing clinician. This case presentation provides insight into the challenges regarding the management of the coronary artery aneurysm during the perioperative period.

Acute myocardial infarction associated with multiple giant coronary artery aneurysms: a management dilemma.

A 77-year-old man presented with an acute inferior ST-segment elevation myocardial infarction.

Surgical treatment of a giant right coronary aneurysm.

This case report is a step-by-step description of the surgical treatment of a giant right coronary aneurysm with a maximum diameter of 80 mm in a 57-year-old male.

Giant right coronary artery aneurysm: the saphenous vein bridge technique.

A giant coronary artery aneurysm is defined as an irreversible dilation that is 1.5-times more than the diameter of a healthy adjacent coronary artery. It is a rare disease with an incidence of 0.2% to 4.9%. Coronary artery aneurysms are usually corrected with a coronary artery bypass graft. We describe how to perform a saphenous vein bridge to repair a giant coronary artery aneurysm. When applicable, this technique allows sparing of the coronary artery ostia and restores the coronary anatomy.

Left main coronary artery aneurysm with fistula to superior vena cava: A challenging case.

Coronary artery fistulas (CAFs) are rare congenital coronary artery abnormalities, with direct communication between a coronary artery and a cardiac chamber, great vessel or other structure. We report here, a rare case of a 25-year-old male with CAF from the aneurysmal left main coronary artery to the superior vena cava detected on echocardiography and computerized tomography (CT) coronary angiography.

Giant right coronary artery aneurysm in a dominant right system.

Giant coronary artery aneurysms (GCAAs) are unusual and extremely rare. Due to their rarity, there is a lack of data on managing GCAAs. A man in his 70s who presented with worsening shortness of breath and bilateral lower extremity oedema was found to have non-ST elevation myocardial infarction. Coronary angiography showed a tortuous Shepherd's crook right coronary artery with ectasia and a gigantic 4.5×4 cm saccular aneurysm in the mid-right coronary artery with limited flow to the distal vasculature. He subsequently underwent aneurysmal clipping and excision with coronary artery bypass grafting. GCAAs are usually silent and diagnosed incidentally but can also present with variable cardiac symptoms. Treatment options include medical management, percutaneous coronary angioplasty and surgery. As per limited available literature, surgical resection has shown favourable outcomes, especially in symptomatic GCAAs. The patient reported significant symptomatic improvement on the follow-up office visit.

Successful surgical management of a single coronary artery with giant coronary artery aneurysm with fistula to the right ventricle.

A giant coronary artery aneurysm (GCAA) concurrent with coronary artery fistula is a rare condition, and it becomes even more unusual when combined with a single coronary artery (SCA) anomaly. Here, we report such an extremely rare case, who is a 35-year-old woman presenting with severe chest distress. A GCAA with fistula to the right ventricle was noted, occurring in a single coronary artery, diagnosed by multimodality cardiovascular imaging techniques. Both GCAA and coronary artery fistula can cause severe cardiac complications, which jeopardize life. While an SCA is mostly asymptomatic, it may also lead to sudden cardiac death as well. Therefore, surgical intervention was recommended. We chose a novel thrombus-inducing strategy to eliminate the GCAA and repair the fistula. Symptoms were relieved after the surgery, and the patient remained asymptomatic over 8 months of follow-up.

Ten-Year Clinical Observation of Immunoglobulin G4-Related Coronary Periarteritis with Aneurysms.

Coronary periarteritis with aneurysms has been reported as a cardiovascular manifestation of immunoglobulin G4 (IgG4) -related disease. We report a 10-year clinical observation of a patient with IgG4-related coronary periarteritis (IgG4-rCP) characterized by multiple thickening of periarterial tissue and coronary artery aneurysms (CAAs).A 60-year-old man with a history of IgG4-related autoimmune pancreatitis had an incidental detection of a total of 5 tumor-like lesions surrounding the right and left coronary arteries on coronary computed tomography angiography (CCTA) in 2012. Among them, 3 lesions were located at the middle to the distal portions of the right coronary artery (RCA) and the most proximal lesion was accompanied by a CAA. Although corticosteroid therapy was continued, 4-year follow-up of CCTA in 2016 showed the most proximal lesion gradually increased from 33 to 45 mm and the CAA enlarged from 9 to 22 mm. In order to avoid aneurysmal rupture, the patient underwent resection of the most proximal lesion with an enlarged aneurysm concomitant with coronary artery bypass grafting (CABG). Histopathological findings were coincident with IgG4-rCP. CCTA in 2018, however, showed the remaining distal tumor-like lesion of RCA had slightly enlarged and a new CAA developed despite the corticosteroid therapy. Follow-up CCTA in 2022 revealed the CAA increased to 13 mm, which showed rapid enlargement by 4 mm/year. A second operation through a re-median sternotomy was planned. The residual lesions with the CAA were resected followed by CABG. The other lesions at the left coronary artery remained stable without aneurysmal change, but careful follow-up has been continued.

[Successful Open Surgical Repair of Asymptomatic Coronary Artery Fistula with Giant Aneurysm: Report of a Case].

Coronary artery fistula is an uncommon congenital anomaly of the coronary arteries, and there are lots of variations. We present a-46-year-old male patient with abnormal cardiac silhouette on chest X-ray. Coronary computed tomography (CT) angiography showed coronary artery (left anterior descending artery)-to-pulmonary artery fistula with a giant aneurysm( 55 mm). Considering the risk of rupture, surgery was indicated. The patient underwent surgical repair through median sternotomy under cardiopulmorary bypass and cardiac arrest antegrade myocardial protection. Fistulas were dissected and ligated proximally and distally, then the aneuysm was resected. By flushing bloody cardioplegic solution, we confirmed that there was no residual blood inflow to the aneurysm. Post-operative course was unevenful without evidence of myocardial injury. The patient discharged home on 10th postoperative day.

Ruptured mycotic coronary artery aneurysm.

Aneurysms complicated by rupture of the coronary arteries are exceedingly rare. Literature regarding management of mycotic aneurysms resulting in rupture is limited. Therefore, we describe a fascinating diagnosis, imaging progression and management of a ruptured mycotic coronary artery aneurysm.

[Acute Coronary Syndrome in a Patient with Giant Coronary Artery Aneurysm:Report of a Case].

Coronary artery aneurysm is a rare entity defined as expansion more than 1.5 times of normal coronary artery in diameter. A 77-year-old male was admitted to our hospital with a diagnosis of acute coronary syndrome and a giant right coronary artery aneurysm. Coronary angiography showed occlusion of the right coronary artery and significant stenosis of left anterior descending artery and left circumflex artery. Enhanced computed tomography( CT) showed a right coronary artery aneurysm with a diameter of 38 mm. Urgent coronary artery bypass grafting and coronary artery ligation proximal and distal to the aneurysm were performed. His postoperative course was uneventful.