Giant aneurysm of the right coronary artery and magnetic resonance coronary angiography

Abstract

Coronary artery aneurysm (CAA) is generally defined as coronary dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient’s largest coronary vessel by 1.5 times. The prime cause of CAAs is atherosclerosis, and the most commonly affected artery is the right coronary artery. CAAs are quite commonly detected during X-ray coronary angiography. However, Coronary artery aneurysm (CAA) is generally defined as coronary dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient’s largest coronary vessel by 1.5 times. The prime cause of CAAs is atherosclerosis, and the most commonly affected artery is the right coronary artery. CAAs are quite commonly detected during X-ray coronary angiography. However, giant CAAs, especially with the diameter exceeding 100 mm, are extremely rare. The treatment method of choice of giant CAAs is the excision of aneurysm with coronary artery bypass grafting. We present a case of a 41-year-old apparently healthy woman with a giant right CAA. This was detected by noninvasive methods, including magnetic resonance coronary angiography, and its maximum diameter exceeded 100 mm. In emergency, the aneurysmal sac was excised and the aortocoronary saphenous vein graft was performed. We also present a review of the published studies of giant CAAs with the diameter exceeding 100 mm.

High-output heart failure due to a giant left circumflex coronary aneurysm with a left atrial fistula and atrial septal defect: a case report

“…There were two cases of left circumflex artery involvement, one case of left main coronary artery involvement, one case of left anterior descending artery involvement, and one case involving both the left main and left anterior descending coronary arteries. 4 Five cases had fistulous connections with one case involving the left circumflex coronary artery and right atrium, two cases involving the right coronary artery and coronary sinus, and two cases of left ventricular fistulas from the left anterior descending artery and right coronary artery. 5–8 …”

“…Among the reported outcomes, 90% (19/21) of patients experienced an unremarkable immediate post-operative period and two patients died during the post-operative period. 4 One had the largest reported right coronary artery aneurysm of 16 cm compressing the right ventricle which became akinetic following resection despite mechanical circulatory support. 9 The other had recurrent ventricular tachycardia prior to surgery which was complicated by thrombosis around the right atrium and multiorgan failure.…”

“… 10 Amongst six patients with reported follow-up period of 1–59 months, there was resolution of symptoms and anatomic stability on repeat imaging. 4 …”

Usefulness of multimodality cardiac imaging in a patient with ST elevation myocardial infarction caused by two giant coronary artery aneurysms

“…Generally, CAA is diagnosed by transthoracic echocardiography, CAG and CT. A few reports have mentioned the use of MRI for diagnosing CAA 15 16. Particularly, cine MRI can be used to image cardiac motion, including CAA, turbulence of blood flow and myocardial asynergy by aneurysm.…”

Dual Aneurysms of the Left Anterior Descending Coronary Artery Initially Detected by Echocardiography

“…The ultrasonic features and main diagnostic points of right CAAs are similar to those of left CAAs; detecting a cystic structure containing no echogenicity adjacent to the course of the RCA and visualizing the color Doppler flow into the aneurysm from the donor RCA are conclusive. 43) In addition, the inspection should focus on tracing the course of the RCA to see whether it might compress the right atrium, right ventricle, or PA. In addition to echocardiography, CAG and coronary CTA are complementary imaging tools for the diagnosis of CAAs.…”