Surgical Management of a Giant Right Coronary Artery Aneurysm With Coronary Arteriovenous Fistula: Case Report

Background
Coronary artery aneurysms are uncommon, and giant aneurysms (> 2cm) are even more unusual. Coronary atherosclerosis and Kawasaki disease are the principal causes. The management of patients with this entity is controversial. There are no clear recommendations on this topic because the literature is confined to report cases and small case series.

Case Summary
The authors describe the case of a 77-year-old woman with a giant saccular aneurysm arising from the right coronary artery ostia and a coronary artery fistula from the right and left coronary arteries to the coronary sinus. The patient underwent surgery through a median sternotomy, the aneurysm was opened and resected; the right coronary artery was ligated at the distal end of the aneurysm, and a saphenous vein graft was used to bypass the distal right coronary artery. A coronary arteriovenous fistula from the distal portion of the right and anterior descending coronary artery to a severely enlarged coronary sinus was found and corrected with an autologous pericardial patch, as well as an atrial septal defect and a severe tricuspid regurgitation. The postoperative course was uneventful.

Discussion
The authors consider surgical management as the best approach for giant coronary artery aneurysms in cases when complications such as rupture and death are very likely. There are very few reports in the literature of coronary aneurysm measuring more than 5 cm associated with coronary artery fistulas.

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