Coronary Artery Aneurysms, Arteriovenous Malformations, and Spontaneous Dissections-A Review of the Evidence

BACKGROUND

Coronary artery aneurysms (CAAs), coronary arteriovenous malformations (CAVMs), and spontaneous coronary artery dissections (SCADs) are rare clinical entities, and much is unknown about their natural history, prognosis, and management.

METHODS

A systematic search of MEDLINE, Embase, and Cochrane Library databases was performed in March 2023 to identify published papers related to CAAs, CAVMs, and SCADs.

RESULTS

CAAs are found in 0.3% to 12% of patients undergoing angiography and are often associated with coronary atherosclerosis. They are usually asymptomatic but can be complicated by thrombosis in up to 4.8% of patients and rarely by rupture (0.2%). CAAs can be managed medically, percutaneously with stents or coil embolization, and surgically. The most common surgical procedure is ligation of the aneurysm, followed by coronary artery bypass grafting. The incidence of CAVMs is 0.1% to 0.2% in patients undergoing angiography, and they are most likely associated with congenital abnormal development of the coronary vessels. The diagnosis of CAVMs is usually incidental. Surgical or percutaneous intervention is indicated for patients with large CAVMs, which carry a potential risk of myocardial infarction. SCADs represent 1% to 4% of all acute coronary syndromes and typically affect young women. SCADs are strongly correlated with pregnancy, suggesting the role of sex hormones in their pathogenesis. Conservative management of SCAD is preferred for stable patients without signs of ischemia as spontaneous resolution is frequently reported. Unstable patients should undergo revascularization either percutaneously or with coronary artery bypass grafting.

CONCLUSIONS

Further evidence regarding the management of these rare diseases is needed and can ideally be derived from multicenter collaborations.

Surgical treatment of a giant right coronary aneurysm

This case report is a step-by-step description of the surgical treatment of a giant right coronary aneurysm with a maximum diameter of 80 mm in a 57-year-old male.

Giant right coronary artery aneurysm: the saphenous vein bridge technique

A giant coronary artery aneurysm is defined as an irreversible dilation that is 1.5-times more than the diameter of a healthy adjacent coronary artery. It is a rare disease with an incidence of 0.2% to 4.9%. Coronary artery aneurysms are usually corrected with a coronary artery bypass graft. We describe how to perform a saphenous vein bridge to repair a giant coronary artery aneurysm. When applicable, this technique allows sparing of the coronary artery ostia and restores the coronary anatomy.

Successful surgical management of a single coronary artery with giant coronary artery aneurysm with fistula to the right ventricle

A giant coronary artery aneurysm (GCAA) concurrent with coronary artery fistula is a rare condition, and it becomes even more unusual when combined with a single coronary artery (SCA) anomaly. Here, we report such an extremely rare case, who is a 35-year-old woman presenting with severe chest distress. A GCAA with fistula to the right ventricle was noted, occurring in a single coronary artery, diagnosed by multimodality cardiovascular imaging techniques. Both GCAA and coronary artery fistula can cause severe cardiac complications, which jeopardize life. While an SCA is mostly asymptomatic, it may also lead to sudden cardiac death as well. Therefore, surgical intervention was recommended. We chose a novel thrombus-inducing strategy to eliminate the GCAA and repair the fistula. Symptoms were relieved after the surgery, and the patient remained asymptomatic over 8 months of follow-up.

Giant right coronary artery aneurysm in a dominant right system

Giant coronary artery aneurysms (GCAAs) are unusual and extremely rare. Due to their rarity, there is a lack of data on managing GCAAs. A man in his 70s who presented with worsening shortness of breath and bilateral lower extremity oedema was found to have non-ST elevation myocardial infarction. Coronary angiography showed a tortuous Shepherd's crook right coronary artery with ectasia and a gigantic 4.5×4 cm saccular aneurysm in the mid-right coronary artery with limited flow to the distal vasculature. He subsequently underwent aneurysmal clipping and excision with coronary artery bypass grafting. GCAAs are usually silent and diagnosed incidentally but can also present with variable cardiac symptoms. Treatment options include medical management, percutaneous coronary angioplasty and surgery. As per limited available literature, surgical resection has shown favourable outcomes, especially in symptomatic GCAAs. The patient reported significant symptomatic improvement on the follow-up office visit.

Long-Term Surveillance of Coronary Artery Dissection in an Orthotopic Heart Transplant Recipient

We describe a case of an orthotopic heart transplant recipient who presented with chest pain related to blunt chest trauma 3 weeks post-transplantation. Electrocardiogram showed anterior ST-segment elevation. Coronary angiography revealed a dissection of the mid-distal left anterior descending artery with preserved antegrade flow. Conservative management of the coronary artery dissection was pursued. While the patient had a favorable long-term clinical outcome, the coronary dissection persisted on 1- and 2-year follow-up coronary angiography.

Left main coronary artery aneurysm with fistula to superior vena cava: A challenging case

Coronary artery fistulas (CAFs) are rare congenital coronary artery abnormalities, with direct communication between a coronary artery and a cardiac chamber, great vessel or other structure. We report here, a rare case of a 25-year-old male with CAF from the aneurysmal left main coronary artery to the superior vena cava detected on echocardiography and computerized tomography (CT) coronary angiography.

[Giant Right Coronary Artery Pseudoaneurysm:Report of a Case]

Giant coronary artery aneurysm is very rare and there is no clear consensus regarding its treatment. Herein, we report a case of this unusual entity. The patient was a 75-year-old man in whom follow-up coronary angiography showed leakage of contrast agent from one of the #4 posterior descending( #4PD) branch of the right coronary artery. Enhanced computed tomography (eCT) revealed a giant pseudoaneurysm with a maximum diameter of 55 mm. Percutaneous balloon angioplasty had been performed in the same vessel for angina pectoris 20 years earlier. We excluded the pseudoaneurysm from arterial perfusion by closing both the wall defect and the culprit branch under cardiopulmonary bypass. There was no need for revascularization because there was another #4PD branch nearby. No adverse events were observed after surgery. Postoperative eCT scans confirmed that the aneurysm was completely thrombosed with no leakage.

[Transient Left Ventricular Dysfunction after Giant Coronary Aneurysm Resection and Repair of Coronary Arteriovenous Fistula with Coronary Artery Bypass Grafting:Report of a Case]

Coronary artery aneurysm with coronary arteriovenous fistula is a relatively rare clinical setting. We report a surgical case of a 69-year-old male with a giant coronary artery aneurysm, finding coronary arteriovenous fistula on computed tomography (CT). We performed complete aneurysm excision and coronary artery bypass grafting with the left internal thoracic artery to the posterolateral branch. The fistula was located between the giant aneurysm on the circumflex artery and the coronary vein close to the coronary sinus, closed with aneurysm sac. The postoperative CT found no residual aneurysm and fistula. However, the great cardiac vein was thrombosed, and the impeded venous flow by the thrombus seemed to reduce the left ventricular ejection fraction (LVEF). Four months after the operation, the LVEF improved to the preoperative level.

[Left Main Coronary Artery-to-left Atrium Fistula with Aneurysmal Dilatation:Report of a Case]

Coronary artery fistula (CAF) is a relatively rare disease, many of which are asymptomatic and are not indicated for surgery. However, CAF's patients with angina, heart failure due to shunt, and fistula hemangiomas are usually indicated for surgical treatment. A 49-year-old woman with severe congestive heart failure was found to have a fistula from the main trunk of the left coronary artery to the left atrium, and a fistula aneurysm. This patient had heart failure due to shunt blood flow, and also had a fistula aneurysm, so surgical treatment was indicated. During surgery, the fistula aneurysm was incised and the origin and opening of the fistula were closed without any problems. The postoperative course is good, and as of three years after the operation, the patient is being followed up at an outpatient clinic without recurrence of shunt flow and heart failure.

[Successful Surgical Repair of Left Coronary Ostial Aneurysm after Modified Bentall Procedure Using the Carrel Patch Technique]

A 38-year-old woman underwent aortic root surgery using the Carrel patch technique at the age of 14 years for annuloaortic ectasia of 59 mm. Although there were no clinical findings of Marfan syndrome or bicuspid aortic valve, the pathological findings of the aortic aneurysmal wall showed degeneration of the media. After 24 years, contrast-enhanced computed tomography (CT) showed an enlargement of the left coronary ostial aneurysm of 17 mm with saccular formation. Re-coronary reconstruction with the Piehler technique using an 8 mm Dacron graft was performed. The post-operative course was uneventful, and post-operative CT showed no pseudoaneurysm or stenosis at the anastomosis sites. The Carrel patch coronary ostial reconstruction has been shown to reduce coronary anastomotic pseudoaneurysms and to improve aortic root surgical outcomes. However, coronary ostial aneurysm is a true aneurysm and one of the later complications after the modified Bentall procedure using the Carrel patch technique. Although it is common in Marfan syndrome, the consensus on diagnosis, operative indication, and surgical procedure have not yet been established. Not only in Marfan syndrome, but also after coronary artery reconstruction using the Carrel patch technique, longer-term follow-up is necessary to take care for aneurysmal formation at coronary ostium.

[A Useful Case of Coronary Angiography during Surgery for Coronary Aneurysms:Report of a Case]

Coronary artery aneurysm with fistula is a relatively rare disease. After surgery, residual coronary fistula is often a problem. To prevent these problems, we perform coronary angiography during surgery, and have good grades. A 70-year-old-woman was admitted to our hospital with a chief complaint of palpitations. Enhanced computed tomography (CT) showed coronary aneurysms. Coronary angiography confirmed the coronary artery aneurysms with fistula to the pulmonary artery. Surgical intervention in the hybrid operating room was performed through median sternotomy with cardiopulmonary bypass. The fistulae were ligated, and the aneurysms were resected. Finally, coronary angiography was performed to confirm that there were no residual shunt aneurysm, or damage to the normal coronary artery, and the operation was completed. Postoperative course was uneventful, and she was discharged on postoperative day 19. Performing coronary angiography during surgery is very useful to confirm the aneurysms are completely closed, coronary artery fistulae are treated, and the coronary arteries are undamaged.

Management of a large intraluminal thrombus in an aneurysmal coronary segment with normal coronary flow

A coronary artery aneurysm (CAA) is an uncommon clinical finding with an incidence of <5% in adults. The presence of a large intracoronary thrombus within an aneurysmal coronary artery and normal coronary flow is usually a very challenging case scenario. Here, we present a case of a patient presenting with typical chest pain symptoms, high-risk findings on a pharmacological nuclear stress test and coronary angiogram showing severe multivessel coronary artery disease, including a large aneurysmal segment within the proximal left anterior descending artery with a large thrombus that did not affect intracoronary flow. Today, there are no published guidelines for the management of CAA with a normal intracoronary flow. The approach used in this case was initial antithrombotic therapy followed by a successful staged percutaneous coronary intervention. Here, we present a case supporting the use of combined intravenous anticoagulant and antiplatelet therapy for 48 hours, followed by successful percutaneous intervention guided by intravascular ultrasound.

[Coronary Aneurysm with Fistula]

We successfully treated two rare cases of coronary aneurysm with fistula. Case 1;A 65-year-old female referred to our hospital with the coronary aneurysm and fistula. Right coronary aneurysm with fistula leading to coronary sinus was observed. Coronary bypass surgery using a saphenous vein to #4PD was performed, and two right ventricle branches were reconstructed. Coronary aneurysm was resected. Case 2;A 46-year-old male was admitted with chest discomfort. Coronary aneurysm with fistula from the left main trunk to left ventricle was demonstrated. Ligation of the coronary artery aneurysm and suture closure of the entry site to the left ventricle was performed. Both patients had uneventful recovery.

Giant Saccular Aneurysm of the Right Coronary Artery

Coronary artery aneurysm (CAA) is defined as a segmental coronary dilation that exceeds the diameter of the adjacent normal coronary artery 1.5 times. Its incidence in the general population is between 1.5% and 5%. However, CAAs over 10 mm are extremely rare. The cause of CAA in this patient with diffuse coronary artery disease was evaluated as atherosclerosis. CAA lesion was not the cause of acute coronary syndrome in our patient. Therefore, CAAS can remain asymptomatic for many years. Individuals with systemic diseases, such as Kawasaki's disease and Behçet's disease, should be followed up for CAAS.

A Giant Left Circumflex Coronary Artery Aneurysm

A patient was referred for aortic valve replacement and aneurysm resection; however, the aneurysm was deemed to be non-resectable due to severe calcification, thus posing a high operative risk. The patient eventually underwent transcatheter aortic valve implantation. Eleven years later, coronary angiography depicted a giant coronary artery aneurysm measuring 63 mm in diameter and containing intraluminal thrombus. To our knowledge, this is the largest giant coronary artery aneurysm reported in the literature.

[Surgical Treatment for Giant Coronary Aneurysm Complicated by Acute Myocardial Infarction and Cardiopulmonary Arrest:Report of a Case]

Giant coronary aneurysm is rare, but a life-threatening disease. We report a 67-year-old man with 39 mm coronary aneurysm. He was presented to our facility with acute coronary syndrome complicated by cardiogenic shock. Angiography demonstrated giant coronary aneurysm and occlusion of the right coronary artery. After cardiopulmonary resuscitation and cardiopulmonary support (PCPS), emergent excision of aneurysm and coronary artery bypass grafting was performed. The postoperative course was good without complications. Most giant coronary artery aneurysms are asymptomatic but some patients present with angina pectoris, sudden death, fistula formation, pericardial tamponade, compression of surrounding structures, or congestive heart failure. But once complications, such as thrombosis, distal embolization, fistula formation or rupture occurred, it is difficult to save life without aggressive surgery. At present, there are no specific guidelines for the treatment of giant coronary aneurysm. Surgical correction is a preferred approach for the treatment of giant coronary artery aneurysms.

[Giant Right Coronary Artery Aneurysm Complicated by Acute Myocardial Infarction:Report of a Case]

The patient was a 45-year-old man who was transported by ambulance to a nearby clinic owing to sudden chest pain. He was diagnosed with myocardial infarction and giant coronary artery aneurysm by coronary arteriogram and underwent an emergency intervention for the myocardial infarction. The patient was referred to our hospital. Intraoperative findings showed the mass-like right coronary artery aneurysm at the anterior to the right atrium. The origin of the right coronary artery was ligated in addition to the fenestration and the proximal and distal regions of the coronary artery aneurysm. It has been reported that coronary artery aneurysms are usually asymptomatic and are often discovered by chance during screenings, such as echocardiography, computed tomography, and coronary arteriogram. Here, we report a surgical case of giant right coronary artery aneurysm complicated by acute myocardial infarction.

[Cardiac Tamponade due to a Ruptured Giant Coronary Artery Aneurysm]

We report a case of a ruptured coronary artery aneurysm. An 87-year-old woman suffered from cardiac tamponade due to a ruptured coronary artery aneurysm. Coronary angiography showed a giant coronary aneurysm without coronary artery fistula. Emergency surgery was performed through median sternotomy. We performed aneurysmectomy and ligation of the perfusion arteries under cardiopulmonary bypass. The patient's postoperative course was uneventful. We also reviewed nine cases of ruptured coronary artery aneurysm without coronary artery fistula in Japan. The disease is a rare clinical state and considered to be an indication for emergency surgery.

[A Giant Right Coronary Artery Aneurysm:Report of a Case]

We report the case of a 49-year-old woman with a giant atherosclerotic thrombus-filled aneurysm of the right coronary artery. She was referred to our hospital because of abnormal finding of the chest X-ray. Echocardiography revealed a large cystic mass adjacent to the right atrium and computed tomography revealed a giant aneurysm of middle segment of the right coronary artery. Based on the size of the aneurysm, the patient underwent exclusion of the aneurysm by proximal and distal ligation and coronary artery bypass surgery. Giant coronary artery aneurysm is rare, and the management should be individualized depending on size, location, and clinical context.

Stent Fracture Induced Infected Pseudo Coronary Artery Aneurysm with Massive Abscess Successfully Treated by Coronary Stent Graft

Infected pseudo coronary artery aneurysm (CAA) is extremely rare, and currently, there is no established treatment. We experienced a rare case of an infected pseudo CAA brought on due to a stent fracture. Following prolonged successful antimicrobial administration, which proved effective in successfully treating the patient, we performed coronary stent graft placement. Although a surgical procedure should fundamentally be the first course of action considered in such cases, when there are concerns as to the degree of invasiveness, our strategy represents a viable option.

Giant coronary sinus aneurysm misdiagnosed as an extracardiac mediastinal tumor

Coronary sinus aneurysm is a rare heart anomaly. Herein, we report a rare case with giant coronary sinus aneurysm misdiagnosed as an extracardiac mediastinal tumor. The preoperative diagnostic imaging failed to diagnose the correct location of the tumor and a simple resection was planned. It turned out to be coronary sinus aneurysm intraoperatively and required cardiopulmonary bypass support for the resection.

[Surgical Repair of Giant Coronary Artery Aneurysm Associated with Coronary-pulmonary Artery Fistulae;Report of a Case]

A 61-year-old woman was referred to our hospital with a complaint of chest compression. Coronary angiography revealed a giant coronary artery aneurysm, located in the middle of a coronary-pulmonary artery fistula originating from the right coronary artery. Another fistula was also shown between the left anterior descending artery and the pulmonary artery. Surgical correction was indicated due to the risks of the aneurysmal rupture and coronary events. Under cardiopulmonary bypass, suture-closure of the coronary artery aneurysm and ligations of the fistulae were carried. Postoperative coronary angiography showed no aneurysm or fistula, and she was discharged uneventfully on the 12th postoperative day.

Prenatal diagnosis of a right coronary artery to right atrial fistula with a giant coronary artery aneurysm: A case report

Coronary artery fistula (CAF) is a rare cardiac anomaly. Here, we diagnosed a right coronary artery-right atrium fistula with giant coronary artery aneurysm (CAA) via fetal echocardiography at 35 weeks' gestation. An urgent caesarean delivery was performed at 36 weeks' gestation because CAA caused mitral obstruction, and fetal atrial flutter was present. Following delivery, we performed aneurysm ligation because the new-born developed atrial tachycardia. The intraoperative findings confirmed the sonographic findings. To the best of our knowledge, prenatal ultrasound diagnosis of CAF and giant CAA has not been reported in the literature. We focus on the ultrasonic characteristics and differential diagnosis in this literature.

Post Heart Transplantation Coronary Artery Fistula and Coronary Artery Aneurysm Successfully Managed With the Implantation of Covered Stents

Coronary-to-cardiac chamber fistulae and coronary aneurysms are potential complications after heart transplantation. In the setting of exercise intolerance and large fistulae at major coronary vessels, covered stents may provide an effective interventional strategy.

Giant Circumflex Aneurysm With Arteriovenous Fistula Surgery Guided by Three-Dimensional Printing

A giant coronary artery aneurysm is an infrequent anomaly encountered as an incidental finding. An even more rare condition is its association with a coronary artery fistula. We report the case of a 61-year-old woman that combines two of the rarest coronary anomalies: a 70-mm giant circumflex aneurysm with an arteriovenous fistula tract draining to the superior vena cava. Considering the unique display of anatomy, the surgery was guided with 3-dimensional printing technology. Direct fistula occlusion near its outflow union, orifice source closure, aneurysmal sac exclusion, and two coronary artery bypass grafts were surgically performed. The postoperative course was satisfactory.

Coronary sequelae of Kawasaki disease treated with rotational atherectomy and drug coated balloon: A case report

INTRODUCTION

Kawasaki disease (KD) is an acute vasculitis syndrome that mainly affects children and is the first cause of acquired heart disease. Coronary artery lesion is the most serious complication of KD. Only two previous studies have reported similar cases, but we reported patient was younger and had a longer follow-up.

PATIENT CONCERNS

We reported a case of coronary sequelae of KD treated with rotational atherectomy and drug coated balloon (DCB). During the week after surgery, the patient complained of a slight chest pain intermittently, but no longer appeared after that.

DIAGNOSIS

We diagnosed by electrocardiogram and angiography. Angiography showed that the anterior descending branch (LAD) proximal stenosis was 95%, the right coronary artery (RCA) middle stenosis was 99%, and the calcification was severe.

INTERVENTIONS

We treat the patient with rotational atherectomy using a 1.25 mm burr, pre-dilatation of the stenosis lesion with a 3.5 mm × 15 mm non-compliant balloon was achieved. Then 3.5 mm × 15 mm drug eluting balloon was inflated at 10 atm for 60 seconds.

OUTCOMES

After the 6-month follow-up (from October 2018 to March 2019), the symptom of angina disappeared. Coronary angiography 6 months later showed no apparent progression of vessel narrowing.

CONCLUSION

The present case suggests that rotational atherectomy followed by DCB dilation could be an alternative revascularization therapy of choice in coronary KD sequelae complicated with atherosclerosis.

Large Right Coronary Artery Aneurysm

Complications of aneurysm include thrombosis and distal embolization, rupture, and vasospasm. The natural history and prognosis remain obscure. Controversies persist regarding the use of surgical or medical management.

Magmaris Resorbable Magnesium Scaffold Implantation Assisted by Optical Coherence Tomography to Treat an Acute Coronary Dissection After a Blunt Chest Trauma

The treatment of coronary lesions caused by blunt chest trauma is controversial. To our knowledge, this is the first report of a coronary dissection related to blunt chest trauma evaluated with OCT and treated with a magnesium resorbable scaffold.

[Coronary Artery to Pulmonary Artery Fistula with a Large Coronary Artery Aneurysm Detected by Multi-detector Row Computed Tomography;Report of a Case]

We report a case of coronary artery to pulmonary artery fistula with a large coronary artery aneurysm (80 mm). A 62-year-old man was referred to our hospital because of syncope without heart failure. Electrocardiogram abnormality and asynergy in the anteroseptal wall were detected on echocardiography. Coronary angiography and multi-detector row computed tomography( MDCT) showed a large coronary artery aneurysm and coronary artery to pulmonary artery fistula originating from the right coronary artery( RCA), left main trunk( LMT) and left anterior descending artery( LAD). The fistula was treated using ligation and endocardial closure, and the aneurysm was resected without coronary artery bypass grafting. Postoperatively, MDCT showed that the fistula and aneurysm had disappeared. MDCT was useful for understanding the spatial relation of the coronary artery to pulmonary artery fistula.

[Surgery in Elderly Patient for Coronary Arteriovenous Fistula and Giant Coronary Artery Aneurysm Associated with Cardiac Failure;Report of a Case]

An 82-year-old woman visited the hospital with the chief complaint of dyspnea on light exertion. Computed tomography (CT) showed a coronary artery aneurysm and coronary arteriovenous fistulas. The pulmouary flow/systemic flow (Qp/Qs) ratio was 1.4, and the left-to-right shunt rate was 31%.Two anomalous vessels were identified. One arose from the right coronary artery, formed an aneurysm, and drained into the coronary sinus, while the other originated from the distal circumflex branch and drained directly into the coronary sinus. The aneurysm measured 50×45 mm. The anomalous vessel from the right coronary artery was ligated at the sites of flow from the right coronary artery and at the site of drainage into the coronary sinus. The circumflex artery was ligated at the last branch and at the site of drainage into the coronary sinus. The aneurysm was incised and the vessel flowing into the aneurysm was sutured closed. Postoperative CT showed no anomalous blood vessel and the circumflex artery was visualized up to the last branch.

[Ruptured Coronary Artery Aneurysm Associated with Coronary Artery Fistula;Report of a Case]

We report a case of a ruptured coronary artery aneurysm associated with coronary artery fistula. A 63-year-old man was suffering from cardiac tamponade due to a ruptured coronary artery aneurysm. An emergency operation was performed to repair the aneurysm. Under cardiopulmonary bypass, all inlet and outlet vessels were sutured and closed. The patient recovered uneventfully. A postoperative coronary computed tomography(CT) angiogram showed extinction of the aneurysm.

[Surgical Treatment of Giant Coronary Artery Aneurysm Presented as Acute Coronary Syndrome]

Coronary artery aneurysm is rare disease, usually asymptomatic and is often found by chance by echocardiography, computed tomography(CT) and coronary angiography. However, its rupture or thrombotic obstruction to the periphery of the coronary artery leads to cardiac tamponade, angina pectoris, or myocardial infarction. We describe 2 cases of giant coronary artery aneurysm presented as acute coronary syndrome. Surgical resection of the aneurysm and coronary artery bypass grafting were successfully carried out under cardiopulmonary bypass. Postoperative courses of both cases were uneventful, and the patients were free of symptoms.

[Surgery for Left Main Coronary Artery Aneurysm with Severe Triple Vessel Disease;Report of a Case]

Coronary artery aneurysm is a rare disease and its surgical indication is still controversial. We present a 63-year-old male having left main coronary artery aneurysm with 6 mm in diameter and symptomatic severe triple vessel disease. It was saccular and expanding into the myocardium. The patient successfully underwent off-pump quadruple coronary artery bypass and suture ligation of the aneurysmal neck. We believe that this technique is effective and less invasive to manage small or medium-sized coronary artery aneurysm in case aneurysmal shape, size, and location should be fitting for it.

Intraoperative identification and treatment of a giant right coronary artery aneurysm

Giant coronary artery aneurysms are rare, difficult to diagnose, and have variable clinical presentations and treatment options. We demonstrate a case of a patient presenting with acute onset chest pain and signs of cardiac tamponade who then underwent a computed tomography pulmonary embolus protocol and was found to have hemopericardium with accumulation of contrast adjacent to the aorta. She then underwent emergent sternotomy and was found to have a large hemorrhagic mass on the right ventricle, which upon further dissection was determined to be a giant right coronary artery aneurysm with a site of contained rupture. Given the acuity of the presentation and the circumstances in which the giant coronary aneurysm was identified, the decision was made to ligate and bypass the affected coronary artery.

[Rupture of Coronary Artery Aneurysm with Coronary Artery to Pulmonary Artery Fistula;Report of a Case]

We report a rare case of ruptured coronary artery aneurysm. A 58-year-old woman experienced a sudden chest pain. Coronary arteriography( CAG) and computed tomography(CT) showed pericardial effusion and 2 saccular coronary artery aneurysms connected by a communicating artery. The 1st one was originated from the right coronary artery and flowed to the communicating artery. The 2nd one was originated from both the diagonal branch and the communicating artery, and flowed to the main pulmonary artery, forming a fistula. Since the 1st one was larger, it was suspected to be the rupture site. Emergency operation was performed and the aneurysms were directly closed under cardiopulmonary bypass. The postoperative course was uneventful.

Treatment of Diffuse Right Coronary Aneurysmal Disease With Standard Drug-Eluting Stent Scaffolding of Polytetrafluoroethylene-Covered Stents

Demonstration of a novel technique to safely exclude long aneurysmal segments that require multiple covered stents in a single segment. In addition, these images and video series demonstrate the usefulness of balloon-assisted GuideLiner tracking to pass bulky equipment to the distal segments of heavily diseased vessels.