Giant right coronary artery aneurysm presenting as cardiac tamponade

A Giant Left Circumflex Artery Aneurysm with Thrombosis Formation Presenting as a Left Atrioventricular Groove Mass

A coronary artery aneurysm is defined as the dilation of a coronary artery segment that is 1.5-fold the diameter of the neighboring normal segments. A patient with a history of aortic valve replacement and coronary artery bypass graft surgery, transthoracic echocardiography revealed a large mass with an echolucent center in the left atrioventricular groove. Transesophageal echocardiography showed that the left atrial appendage was free of thrombosis, and there was a mass with an echolucent center beneath the left atrial appendage, suggestive of aneurysmal dilation in the left circumflex artery with thrombosis formation Coronary artery computed tomography angiography confirmed this finding. In patients with or without a history of coronary aneurysms, the presence of a mass in the atrioventricular groove on echocardiography should alert clinicians about the presence of a coronary artery aneurysm with thrombosis formation as a probable etiology.

Congenital right coronary artery aneurysm with fistula to right ventricle associated with isolated pulmonary valvular stenosis

Congenital aneurysmal dilatation of coronary artery with coronary cameral fistula is rare in childhood. We report an even rarer association of congenital right coronary artery aneurysm and right coronary artery to right ventricle fistula with bicuspid pulmonary valve stenosis and an intact ventricular septum in a 3-year-old child.

Challenging surgery of giant right coronary aneurysm associated with coronary sinus fistula

Coronary artery fistula is a rare congenital or acquired anomaly. It involves an abnormal connection between the coronary artery and the cardiac chambers or the large thoracic vessels. In some cases, the feeding coronary artery can become extremely dilated. The treatment includes a transcatheter or a surgical intervention depending on the complexity of the anomaly. We present the surgical treatment of the coronary artery to coronary sinus fistula, which includes the complete exclusion of the giant right coronary artery and followed by triple bypass surgery.

Surgical resection of the giant right coronary artery aneurysm

A 74-year-old man had undergone two-vessel coronary artery bypass grafting (CABG), 19 years ago, with the left internal mammary artery (LITA) to the left anterior descending artery and the saphenous vein graft (SVG) to the posterior descending artery. In outpatient care, a thoracic aortic aneurysm was suspected by the chest X-ray. In the computed tomography, appeared the distal arch aortic aneurysm, abdominal aortic aneurysm (AAA), and giant right coronary artery aneurysm (rCAA). The diameter of rCAA was 70 mm and it oppressed the right atrium and ventricle of the heart. The patient was referred to our hospital. After the initial treatment of distal arch aneurysm and AAA, surgical treatment for the rCAA was performed. The rCAA was resected completely and CABG with new SVG was performed without cardiopulmonary bypass. The histopathology of rCAA wall revealed that the etiology was an atherosclerotic change. The postoperative course was good, the oppressed right heart system was released and the hemodynamics of the tricuspid valve showed improvement.