Multiple Giant Coronary Artery Aneurysms Surgically Treated with Bypass Grafting: A Challenging Rarity

Abstract

Coronary artery aneurysms are encountered in daily cardiology practise but multiple giant-sized coronary artery aneurysms are extremely rare. We present an illustrative case of multiple giant aneurysms located throughout the coronary system (left main stem and all left, right, and circumflex branches) in a 57-year-old male with acute coronary syndrome. The case was managed successfully with on-pump quadruple coronary artery bypass grafting. To our knowledge, few cases of multiple giant aneurysms in all coronary vessels have been reported.

Figure 1

A 3D reconstruction image of the heart. In (a), the white arrows show the left coronary system with aneurysmal main stem and LAD (black arrows) and circumflex artery. In (b), the black arrows show the spherical giant aneurysm of the RCA which measures more than four centimeters.

Figure 2

Intraoperative images. The black arrows in (a) show the giant CAA which is larger than the nearby aortic root (Ao) and the right atrium (RA). In (b), the RCA aneurysm is dissected open, and after thrombus debridement, the stenotic vessel lumen is indicated with a black arrow in (c). In (d), the main stem and LAD are dissected open and endarterectomy is performed. In (e), the atherosclerotic cast is measured before it was sent for histopathology and microbiology investigations.