A Case of Giant Coronary Artery Aneurysm with Fistulous Connection to the Pulmonary Artery: a Case Report and Review of the Literature

Abstract

Giant coronary artery aneurysm is a rare condition with a reported prevalence of 0.02%. Herein, we report the case of a 79-year-old woman with a giant coronary aneurysm arising from a branch of the left anterior descending coronary artery that had a fistulous connection to the pulmonary artery. The aneurysm was removed and inflow and outflow arteries were closed surgically. Histology showed prominent mucinous degeneration and infiltration of inflammatory cells in the medial layer. After successful surgery, the patient was discharged uneventfully.

Rare Case of Giant Non-Thrombosed Coronary Artery Aneurysm at the Left Anterior Descending Coronary Artery

“…3 Most gCAA have thrombus formation in aneurysms, and distal embolism of thrombus can result in fatal myocardial infarction, but no thrombus was observed in the present case. The reason for the lack of thrombus in this case may be that the high blood flow in the aneurysm because of the high pressure gradient between the aorta and pulmonary artery prevented formation of thrombus.…”

Giant Coronary Artery Aneurysms: Review and Update

“…2,4-6,9,10,12-14, [16][17][18][19]21,[23][24][25]27,28,30,32,[34][35][36][37]39,40 Similarly, the usual cause of giant CAAs is atherosclerosis, but other causes have been described. Keyser and colleagues 30 presented a compilation of 28 cases of giant CAA (exceeding 50 mm in size) reported over a period of 49 years.…”

“…2,4,5,7,9,12,19,21,23,28,29,32,36,40,41 A frequent finding is the presence of thrombus within the aneurysm. 1,4,7,11,13,14,16,23,30 The slow flow of the blood and the irregular internal surface of the aneurysmal wall predispose the lesion to this development.…”

“…Several investigators have reported a greater incidence of myocardial infarction in patients with aneurysmal disease. 1,10,13,26,39 In a review of case reports published in 2011, Morita and colleagues 28 found that 25% of patients with a giant CAA had an associated fistula. Ipek and associates 29 reported a case of a giant right coronary artery aneurysm with a coronary-cameral fistula.…”

“…A universally accepted definition of a giant CAA does not exist: diameters of greater than 20 mm, 40 mm, 50 mm, and quadruple the referencevessel diameter have all been proposed as definitive in the medical literature. 7,17,21,25,28 Published data on giant CAAs report a prevalence of 0.02% to 0.2% (the prevalence of giant CAAs ≥50 mm in diameter is 0.02%).…”