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Case Reports
. 2020 Apr 23;13(4):e234203.
doi: 10.1136/bcr-2019-234203.

Successful sparing approach between the ascending aorta and the main pulmonary artery to the giant coronary aneurysm of the left main coronary artery

Ken Nakamura  1 , Kouan Orii  2 , Takayuki Abe  2 , Hirofumi Haida  2
Affiliations
Case Reports

Successful sparing approach between the ascending aorta and the main pulmonary artery to the giant coronary aneurysm of the left main coronary artery

Ken Nakamura et al. BMJ Case Rep. .

Abstract

Coronary aneurysm located just above the left main coronary artery (LMT) is rare and difficult to treat. How the aneurysm is accessed is very important as it determines the result of the surgery. A 70-year-old man with a large coronary aneurysm (40 mm in diameter) in the LMT underwent surgery to prevent its rupture; however, there was severe adhesion. Initially, dissection of the ascending aorta or the pulmonary artery seemed necessary to access the aneurysm; however, the process was possible with limited dissection between the ascending aorta and the pulmonary artery, and we succeeded in firmly closing the LMT site of entry.

Keywords: cardiothoracic surgery; cardiovascular medicine.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Cardiac catheterisation. (A) Cardiac catheterisation revealed jet blood flow 10 mm away from the left main coronary orifice. (B) Coronary artery CT showing a giant saccular coronary aneurysm with a diameter of 40 mm on the posterior side of the pulmonary artery. LMT, left main coronary artery.
Figure 2
Figure 2
The surgery. (A) A large amount of thrombus filled the aneurysm. (B) The entry point (arrow) was closed by 5–0 and 4–0 Prolene sutures with felt strips. Ao, aorta; LMT, left main coronary artery; PA, pulmonary artery.
Figure 3
Figure 3
Coronary artery CT after surgery confirmed the disappearance of the coronary aneurysm and its drainage artery. LMT, left main coronary artery.
See this image and copyright information in PMC

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