Giant coronary artery aneurysm with fistula to the pulmonary artery complicated by frequent ventricular premature contractions: a case report

Abstract

Giant coronary artery aneurysm with a fistula is a rare condition. The presence of a giant aneurysm imposes considerable health risks. We report a case of a 67-year-old woman who presented with frequent ventricular premature contractions caused by a giant coronary aneurysm arising from a branch of the left anterior descending coronary artery that had a fistulous connection to the pulmonary artery. The patient was referred for cardiac surgery. The giant aneurysm was resected, and the proximal and distal openings were closed directly. The main pulmonary artery was opened longitudinally and the fistula was also closed directly. The patient's symptoms of frequent ventricular premature contractions disappeared postoperatively as confirmed by electrocardiography. Although the standard therapeutic strategies of the disease are not well established because of the rarity of this condition, our clinical results indicate that the surgical treatment is an effective choice.

FIGURE 1

Preoperative cardiac images. A and B. Two-dimensional transthoracic and transesophageal echocardiography. A large cystic mass containing smoke-like echoes was observed adjacent to the ectatic left anterior descending artery. Blood flow into the pulmonary artery could be observed as color Doppler signals (yellow arrow: coronary artery aneurysm, white arrow: coronary artery fistula, green arrow: pulmonary artery) C. Axial section of CT image. Coronary artery aneurysm (dimensions 32 × 33 mm) with heterogenic contrast enhancement is seen (yellow arrow). D. Three-dimensional heart reconstruction of CT images. A giant coronary artery aneurysm was present at the branch artery of the left anterior descending artery (LAD), and the proximal portion of LAD was dilated and tortuous (yellow arrow: coronary artery aneurysm, green arrow: pulmonary artery). E. Coronary angiography. Left coronary artery angiography demonstrated a giant coronary aneurysm originating from branch of LAD with a fistulous connection to the pulmonary artery (yellow arrow). Postoperative cardiac images. F. Coronary angiography. The coronary artery aneurysm and coronary artery fistula disappeared (yellow arrow). Electrocardiography: G. Preoperative electrocardiography revealed frequent ventricular premature contractions. H. Postoperative electrocardiography revealed no frequent ventricular premature contractions.