Abstract
BackgroundCoronary 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 presentationA 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.ConclusionOn the basis of this case, we propose considering rupture of a CAA as one of the causes of cardiac tamponade.
Highlights
Coronary artery aneurysm (CAA) is defined as dilatation exceeding 1.5 times the width of the normal adjacent coronary artery segments
We describe a patient with acute cardiac tamponade caused by spontaneous rupture of giant CAA with a coronary arteriovenous fistula (CAVF), who underwent successful emergency surgery
Cardiac tamponade due to either rupture of CAA or CAVF was diagnosed, and emergency surgery was performed through a median sternotomy
Summary
Coronary artery aneurysm (CAA) is defined as dilatation exceeding 1.5 times the width of the normal adjacent coronary artery segments. Those with a diameter > 20 mm are referred to as giant CAA [1]. We describe a patient with acute cardiac tamponade caused by spontaneous rupture of giant CAA with a coronary arteriovenous fistula (CAVF), who underwent successful emergency surgery. Case presentation A 79-year-old woman was transferred to a nearby hospital because of presyncope and back pain. Cardiac tamponade due to either rupture of CAA or CAVF was diagnosed, and emergency surgery was performed through a median sternotomy. The patient remained well as of the 4-year follow-up, showing no expansion of the small coronary aneurysm
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