A previously healthy 58-year-old man presented to the emergency department with 8/10 chest pain radiating to his back. His blood pressure was 160/100 mm Hg. The electrocardiogram showed anterolateral ST elevation consistent with acute myocardial infarction. A computer tomography scan with intravenous contrast ruled out aortic dissection, but it showed an aneurysm of the ascending aorta. Coronary angiography revealed a giant coronary aneurysm arising soon after the right coronary ostia, and severe coronary disease showed in the left anterior descending (LAD) and circumflex coronary (Cx) arteries. The patient underwent coronary artery bypass surgery and right coronary aneurysm exclusion. The left internal thoracic artery was used to bypass the LAD, the left radial artery to bypass the Cx, and a reverse saphenous vein in Y graft was used to bypass the acute marginal and the posterior descending arteries. The coronary aneurysm was opened, excluded, and excised. The patient recovered well and was discharged home on postoperative day four.
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