Abstract
BackgroundCoronary artery aneurysms are rare findings in patients undergoing coronary angiography. The presence of multiple coronary artery aneurysms located in more than one coronary artery is even more uncommon. The pathophysiology of such aneurysms is unknown, but the majority are often due to atherosclerosis, congenital heart disease, or vasculitis.Case presentationWe present a rare case of a 78-year-old female patient who presented with unstable angina and non-ST segment elevation myocardial infarction. On coronary angiography, she was found to have three separate 1 cm saccular aneurysms involving the proximal left anterior descending coronary artery. The right coronary artery could not be visualized. Computed chest tomography revealed a 6.6 × 6.3 cm saccular aneurysm of the right coronary artery, and a 4.4 cm fusiform aneurysm of the ascending aorta. The patient gave no history of percutaneous coronary intervention or cardiac surgical procedures. She had a previous history of endovascular stenting of an abdominal aortic aneurysm. The sizable right coronary artery aneurysm showed extrinsic compression of both the right atrium and ventricle with right ventricular hypokinesis. Serological studies for vasculitis were all negative. Pathology of the aneurysm wall revealed calcific atherosclerosis without evidence of vasculitis. The patient underwent subtotal resection of the right coronary aneurysm with ligation of the proximal and distal ends of the right coronary artery and double bypass surgery to the left anterior descending and right posterior descending coronary arteries.ConclusionThe presence of multiple, large coronary artery aneurysms is very rare. Treatment can be challenging and should be individualized. Surgical treatment is recommended for giant coronary artery aneurysms to prevent potential complications.
Highlights
ConclusionThe presence of multiple, large coronary artery aneurysms is very rare
Coronary artery aneurysm (CAA) is a rare pathology of the coronary arteries and is present in up to 4.9% of patients undergoing coronary angiography [1]
With a history of endovascular stenting of an abdominal aortic aneurysm who presented with unstable angina and non-ST segment myocardial infarction and was found to have three separate giant 1 cm saccular aneurysms involving the proximal left anterior descending coronary artery (LAD) as well as a giant 6.6 × 6.3 cm saccular aneurysm of the right coronary artery (RCA)
Summary
Giant CAA is a rare occurrence. Simultaneous multiple giant coronary aneurysms involving more than one major coronary artery is even rarer. Surgical treatment is recommended in these instances to prevent potential complications. Abbreviations CAA: Coronary artery aneurysm; RCA: Right coronary artery; LAD: Left anterior descending coronary artery; CT: Computed tomography; RCAA: Right coronary artery aneurysm; RPDA: Right posterior descending coronary artery; CTA: Computed tomography angiography
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