Giant coronary aneurysms exceeding 5 cm in size

Abstract

Giant coronary artery aneurysms (gCAAs) with a diameter exceeding 5 cm are extremely rare. The pathomechanisms and therapeutical measures in such cases have been controversial topics of discussion. Twenty-seven patients with gCAAs exceeding 5 cm in size described in the literature were evaluated. A case with multiple gCAAs at our department was included in the analysis. Apart from atherosclerosis of all coronary arteries, a large (1.5 2.5 cm) left anterior descending coronary artery aneurysm (CAA) and a gCAA (10.6 9.2 cm) originating from the right coronary artery, the latter causing recurrent myocardial ischaemia with the occlusion of the peripheral right coronary artery and compressing the right cardiac cavities, were the pathological findings in our 43-year old male patient. gCAAs predominantly develop at the proximal right coronary artery. The majority of these aneurysms develop secondary to atherosclerotic lesions in young patients. We performed a successful surgical excision of the right gCAA, tightening of the left anterior descending artery aneurysm and concomitant coronary artery bypass grafting. A pathological examination confirmed advanced atherosclerosis. Microbiological examinations could find no signs of infectious causes. CAAs bear a significant risk of severe complications and have a high risk of mortality. A more aggressive surgical approach should be recommended.

A Giant Thrombosed Right Coronary Artery Aneurysm Presenting as an Obstructing Left Atrial Mass.

“…Of eight patients treated conservatively five died, two had an unstated outcome and one had a successful outcome. One patient who underwent a percutaneous intervention did well [1,7].…”

Coronary artery aneurysms in the elderly: Case report

“…There is no accepted preferred management of coronary aneurysms but surgical correction is the most commonly used therapy [8,14,19,21]. Endovascular techniques and conservative medical therapy with either antiplatelets or anticoagulants are other viable options with variable rates of success [9,[21][22][23]. Surgical interventions include aneurysm ligation with distal bypass grafting, isolated coronary artery bypass grafting, aneurysm plication, and saphenous vein patch repair of the aneurysm.…”

Giant coronary aneurysm and arterial tortuosity

“…Coronary artery aneurysm (CAA) is uncommon, and giant CAA is even rarer with an estimated incidence ranging between 0.02% and 0.04% [10,15]. Giant CAA was defined as a CAA with a diameter > 4 times of the reference artery, or with a diameter > 8 mm [9].…”