Cardiac tamponade due to the rupture of the coronary artery fistula

Large Aneurysmal Rupture of Coronary-Pulmonary Artery Fistula After Buffalo Goring

Patient: Female, 55-year-old

Final Diagnosis: Large aneurysmal rupture of coronary pulmonary artery fistula

Symptoms: Chest discomfort

Medication: —

Clinical Procedure: Exclusion of aneurysm • ligation and closure of fistula, with coronary artery bypass graft

Specialty: Cardiology

Cardiac tamponade due to rupture of a giant coronary artery aneurysm with a coronary arteriovenous fistula: a case report

Background

Coronary artery aneurysm (CAA) is defined as dilatation exceeding 1.5 times the width of the normal adjacent coronary artery segments. CAA usually causes few symptoms, and rupture is rare, but can be lethal due to cardiac tamponade when it does occur.

Case presentation

A 79-year-old woman presented with presyncope and back pain. Emergency surgery was performed based on a diagnosis of cardiac tamponade due to either rupture of coronary arteriovenous fistula or CAA. At surgery, a rupture site was located on the wall of the giant CAA, with a diameter of 55 mm, originating from the ostium of the right coronary artery. Suture closure of the inflow and outflow of the aneurysm was performed, and the aneurysmal cavity was obliterated by multiple sutures. The patient made an uneventful recovery and was discharged from hospital on postoperative day 13.

Conclusion

On the basis of this case, we propose considering rupture of a CAA as one of the causes of cardiac tamponade.