Optimal operative strategies in repair of giant coronary artery aneurysms determined by the anatomic futures

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Giant coronary artery aneurysm is a rare coronary abnormality defined as coronary artery aneurysm diameter morethan 20 mm. Here, we describe the management and discuss the operative strategy we selected in the three cases ofgiant coronary aneurysm diagnosed by multidetected computer tomography (MDCT). The first case was a 53-year-oldhemodialysis patient presented with acute myocardial infarction. He underwent emergent percutaneous coronaryintervention on right coronary artery. Several days after the procedure, MDCT disclosed coronary artery aneurysm (26mm in diameter). Surgical resection of the aneurysm and coronary artery bypass grafting without use ofcardiopulmonary bypass were carried out. The second case was a 71-year-old woman. She was pointed out to have acardiac murmur and MDCT revealed a giant coronary artery aneurysm (more than 30 mm in diameter) with coronaryartery fistula located to the right of left anterior descending artery. Her coronary artery fistula and coronary arteryaneurysm were successfully treated by surgery performed under cardiopulmonary bypass. Postoperative course of thefirst and the second cases were uneventful and they were free of symptoms. The third case was a 60-year-old man whohad circumflex artery aneurysm (70 mm in diameter) with fistulous communication to the coronary sinus. Surgicaltreatment involves isolation and resection of coronary artery aneurysm with concomitant myocardialrevascularization. He had a complicated postoperative course, including ventricular tachycardia. The patientsubsequently had a gradual recovery and was discharged home.

Optimal operative strategies in repair of giant coronary artery aneurysms determined by the anatomic futures

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