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

Wednesday, September 2, 2020

Guerrero Becerra AF. Surgical Management of a Giant Right Coronary Artery Aneurysm With Coronary Arteriovenous Fistula: Case Report. September 2020. doi:10.25373/ctsnet.12904034

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.

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.


  1. Gottesfeld S, Makaryus AN, Singh B, Kaplan B, Stephen B, Steinberg B, et al. Thrombosed right coronary artery aneurysm presenting as amyocardial mass. J Am Soc Echocardiogr. 2004;17(12):1319–1322.
  2. Pereira E, Melica B, Primo J, Mota JC, Ferreira N, PM G, et al. Diffuse aneurysmal and obstructive coronary artery disease: a do-not-intervene patient. Rev Port Cardiol. 2013;32(7–8):629–632.
  3. Syed M, Lesch M. Coronary artery aneurysm: a review. Prog Cardiovasc Dis. 1997;40(1):77–84.
  4. Kang SM, Kim JH, Oh J, Shim CY, Choi BW. Cardiovascular images. Giant right coronary aneurysm to left ventricular fistula. Circ Cardiovasc Imaging. 2009;2(3):e15–16.
  5. Buccheri D, Chirco PR, Geraci S, Caramanno G, Cortese B. Coronary artery fistulae: anatomy, diagnosis and management strategies. Heart Lung Circ. 2018;27(8):940–951.
  6. Zenooz NA, Habibi R, Mammen L, Finn JP, Gilkeson RC. Coronary artery fistulas: CT findings. RadioGraphics. 2009;29:781–789.
  7. Hironori Inoue M, Masahiro Ueno MD. Surgical treatment of coronary artery aneurysm with coronary artery fistula. Ann Thorac Cardiovasc Surg. 2009; 15(3):198–202.
  8. Wu QY, Li DY, Hu SS, Pan SW, Qi ST. Surgical treatment of giant coronary artery aneurysm. Asian Cardiovasc Thorac Ann. 2001;9: 215-217.
  9. Crawley PD, Mahlow WJ, Huntsinger DR, Afiniwala S, Wortham DC. Giant coronary artery aneurysms: review and update. Tex Heart Inst J. 2014;41:603–608.
  10. Liu JC, Chan P, Chang TH, Chen RF. Off-pump surgery for multiple coronary artery fistulas with aneurysm. Ann Thorac Surg. 2006;81(2):729–732.


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