EComment. Giant aneurysm of the circumflex artery

Abstract

Keyser et al. have presented an interesting case report [1]. The 43-year old patient underwent a successful excision of a giant (>5 cm in size) aneurysm of the right coronary artery, tightening of the aneurysm of the left anterior descending artery and triple coronary artery bypass grafting. Although we recognize the efforts of Keyser and colleagues to identify the best surgical management of giant coronary artery aneurysms by reviewing the literature, we would like to point out an important point that they have failed to include in their report. The analysis of the relevant articles yielded 27 patients with giant (>5 cm) coronary artery aneurysms. The majority of the cases involved the right coronary artery, while only 11% were localized in the left anterior descending artery. We have previously published a case report [2] about a giant aneurysm involving the circumflex artery. Thus, based on the finding of Keyser et al. and to the best of our knowledge, our case represents the only reported case of a giant aneurysm in the territory of the circumflex artery. The 61-year old male patient was referred for bacterial endocarditis affecting the mitral and the tricuspid valves (grade III mitral regurgitation and grade II tricuspid regurgitation) without left ventricle dysfunction. Coronary angiography and multidetector computed tomography scan revealed a giant (measuring >5 cm in diameter) aneurysm of the circumflex artery with massive calcification of the involved coronary artery and a large fistula to the coronary sinus. The surgical management consisted of closing the fistula thus ligating the outflow of the aneurysm. However, we were discouraged by the calcified wall of the circumflex artery; therefore ligation of the proximal end of the aneurysm was not attempted. A saphenous vein was grafted to the obtuse marginal branch. The patient experienced full recovery and one month after the operation, a near complete occlusion of the aneurysm was depicted in a coronary angiogram. At the last follow-up, four years after the surgery, the patient was doing well. Conflict of Interest: None declared