Giant coronary artery aneurysm with coronary arteriovenous fistula draining into the coronary sinus

Abstract

A 77-year-old patient suffering from a giant right coronary artery aneurysm with coronary arteriovenous fistula was admitted to our hospital. The fistula could not be documented preoperatively by computed tomography or coronary angiography but was documented intraoperatively by transesophageal echocardiography (TEE). However, TEE was unable to visualize the draining site of the fistula. Direct palpation by the surgeon ultimately confirmed that the fistula was draining into the coronary sinus. The fistula was closed and the volume of the aneurysm reduced by partial resection. The postoperative course of the patient was uneventful. Giant aneurysms occasionally displace cardiac structures. In such cases, combined imaging technologies, including TEE, may be needed for precise assessment of the giant aneurysm and fistula.

Multimodality imaging in preparation for surgery of coronary to pulmonary arterial fistulas complicated with a huge coronary aneurysm

“…Only 5% of CAFs originates from the bilateral coronary arteries . 15%–19% of CAFs complicates with coronary artery aneurysm (CAA) . In our case, we found multiple fistulas to PA originating from bilateral coronary arteries with a LAD aneurysm.…”

“…Coronary artery fistula (CAF) is a rare congenital defect that occurs in 0.2%–0.4% of patients with congenital heart disease and 0.1%–0.8% in those undergoing CAG . Only 5% of CAFs originates from the bilateral coronary arteries .…”

Histopathology of Giant Coronary Artery Aneurysm Associated with Coronary Artery Fistula

“…There have been 12 previous case reports of histological changes of giant coronary artery aneurysm (defined as diameter !2 cm) associated with coronary fistula (Table). 4,[8][9][10][11][12][13][14][15][16][17][18] Among those reported cases and the present case (age range, 38 to 79 years; mean age, 64 ± 13 years; four men and nine women; maximum diameter of aneurysm, 33 to 100 mm, and mean diameter, 60 ± 19 mm), the aneurysms were located in the LAD of the left coronary artery in seven patients, in the circumflex of the left coronary artery in two patients, and in the right coronary HISTOPATHOLOGY OF GIANT CORONARY ANEURYSM artery (RCA) in four patients. Further, there was LAD to pulmonary artery fistula in five patients, LAD to the left ventricle fistula in one patient, LAD to the RCA fistula in one patient, RCA to the right atrium fistula in one patient, RCA to the left atrium fistula in one patient, RCA to the left ventricle fistula in one patient, RCA to the coronary sinus fistula in one patient, RCA to the right atrium fistula in one patient, and LCX to the coronary sinus fistula in one patient.…”

A Giant Coronary Artery Aneurysm with Coronary Arteriovenous Fistula in Asymptomatic Elderly Patient

“…A left-to-right shunt exists in more than 90% cases. CAA also occurs in approximately 15–19% of patients with CAF [1]. The reason for this behavior is that a fistula consists of a “nest” of vessels containing fragile smooth muscle, which is susceptible to constant exposure to arterial pressure and much blood flow, resulting in dilatation and aneurysmal change with age [1, 2].…”