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Case Reports
. 2009;36(3):238-40.

Surgical management of multiple coronary artery aneurysms, including the giant form

Sebastian Holinski  1 , Pascal Maria Dohmen, Alexander Lembcke, Wolfgang Konertz
Affiliations
Case Reports

Surgical management of multiple coronary artery aneurysms, including the giant form

Sebastian Holinski et al. Tex Heart Inst J. 2009.

Abstract

Coronary artery aneurysms are clinically relevant, because thromboembolism, rupture, and hemodynamic problems related to compression may occur. Surgical management is not standardized, and an individual approach toward each aneurysm is prudent. Giant coronary artery aneurysms (larger than 20 mm in diameter) originate in different ways and are extremely rare, and their surgical treatment is also not well defined.Herein, we report the case of a 63-year-old man who had 2 aneurysms of the circumflex coronary artery and a 65-mm aneurysm of the right coronary artery. The diagnosis was established by use of transesophageal echocardiography, magnetic resonance imaging, and coronary angiography. An intraoperatively discovered smaller aneurysm of the right coronary artery was ligated. The giant thrombus-filled aneurysm of the right coronary artery was partially resected, because it compressed the right atrium and ventricle. A graft of the greater saphenous vein was constructed to the distal right coronary artery. The smaller, noncompressing aneurysms in the circumflex coronary artery were excluded by means of proximal and distal suture ligation, and bypass grafting was performed with use of skeletonized left internal mammary artery. The procedures were successful. We discuss the reasons behind our individual approach toward our patient's aneurysms.

Keywords: Coronary aneurysm/diagnosis/etiology/surgery; coronary artery disease/complications; coronary thrombosis/complications.

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Figures

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Fig. 1 Preoperative magnetic resonance imaging shows a giant aneurysm of the right coronary artery that compresses the right ventricular inflow tract.
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Fig. 3 Artist's drawing depicts A) the patient's preoperative condition of 4 aneurysms, including the giant aneurysm of the right coronary artery. B) The postoperative drawing depicts the excluded aneurysms, and the bypass grafts to the right coronary artery and the circumflex coronary artery after surgery.
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Fig. 2 Intraoperative photograph shows the opened, thrombus-filled giant aneurysm of the right coronary artery.
See this image and copyright information in PMC

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