Surgical treatment for coronary artery aneurysm: a single-centre experience

Abstract

Objectives: Coronary artery aneurysm is a rare condition with a reported incidence of 0.14-4.9% in patients undergoing coronary angiography and 0.3-5.3% in patients after percutaneous transluminal coronary angioplasty (PTCA). Optimum surgical therapy for this entity is difficult to standardize. We present here a series of 4 cases with the aim of establishing an optimal surgical therapy for this rare entity.

Methods: Four cases of coronary artery aneurysm were admitted in the Department of Cardiology and Department of Cardiothoracic and Vascular Surgery, King George's Medical University, Lucknow, from April 2010 to April 2012. All patients underwent a surgical procedure that involved ligation and plication of the aneurysm with coronary artery bypass grafting.

Results: Out of the four coronary artery aneurysm patients, 1 was atherosclerotic and the remaining 3 patients developed coronary artery aneurysm after PTCA with a drug eluting stent to the left anterior descending artery. After surgery, all patients recovered uneventfully without any recurrence of symptoms in the follow-up.

Conclusions: Coronary artery aneurysm is a rare entity and is being seen more frequently with the increasing use of stents during PTCA. Proximal ligation and plication of the aneurysm with coronary artery bypass grafting in the present series provided good results. With this case series, we seek to establish an optimal surgical therapy for this rare entity.

Keywords: Aneurysm (Coronary); Coronary artery bypass grafting; Coronary percutaneous intervention; Stents (Coronary).

Figure 1:

Coronary angiography reveals a coronary aneurysm of 2.5 cm in diameter in the proximal left anterior descending (LAD) artery (A). Intraoperative photograph showing coronary aneurysm in the proximal LAD (B) (Source: Indian Heart Journal 2012;6402:198–9, permission: obtained).

Figure 2:

Coronary angiography reveals a coronary aneurysm of 3 × 2 cm size in the proximal left anterior descending (LAD) artery (A). Intraoperative photograph of Patient 2 reveals coronary aneurysm of 3 × 2 cm size in the proximal LAD. Off-pump coronary artery bypass grafting (OPCABG) × 1 (LIMA to LAD) has been done (B).

Figure 3:

Coronary angiography reveals a coronary aneurysm of 2 × 2 cm size in the mid-left anterior descending (LAD) artery (A). Intraoperative photograph showing coronary aneurysm of 2 × 2 cm size in the mid-LAD. On-pump beating heart coronary artery bypass grafting (rSVG to the distal LAD) has been done (B).

Figure 4:

Coronary angiography of Patient 4 reveals a coronary aneurysm of 1.5 × 1.5 cm size in the proximal left anterior descending (LAD) artery (A). Intraoperative photograph showing coronary aneurysm of 1.5 × 1.5 cm size in the proximal LAD. Off-pump beating heart coronary artery bypass grafting (rSVG to LAD) has been done (B).