Internal thoracic artery patch repair of a saccular left main coronary artery aneurysm

Abstract

Background A saccular aneurysm located at the bifurcation of the left main coronary artery (LMCA) is an extremely rare condition. A major cause of left main coronary aneurysm is atherosclerosis, and common complications include thrombosis, embolism, and rupture. Despite the serious nature of this condition, the ideal operative approach to LMCA aneurysm (LMCAA) has not been established. Furthermore, little is known about resection of the saccular aneurysm and closure using a small internal thoracic artery patch. Case presentation Here, we present the case of a 66-year-old woman who had significant stenosis in the left anterior descending artery and a saccular aneurysm at the bifurcation of the LMCAA, which was repaired using a small internal thoracic artery patch during coronary artery bypass grafting. Postoperative multislice computed tomography revealed the complete disappearance of the aneurysm and a successful repair with no luminal stenosis of the internal thoracic artery patch. In addition, the left internal thoracic artery graft was found to be patent. Conclusions Resection of the saccular LMCA aneurysm and closure using a small internal thoracic artery patch is safe and offer excellent results.

Recurrent Chest Pain due to a Huge Left Main Aneurysm: A Case Report

“…Chen et al 9 described a 22-year-old man with an aneurysm in the LMCA and the left circumflex and a clot in the latter coronary artery. No clots were, however, reported in the LMCA of a 66-year-old man with a huge LM aneurysm, 10 which is consistent with the present report, suggesting no clots in the LMCA of the case with no history of risk factors. Moreover, certain points about our case distinguish it from the case reports cited above: not only was the size of the aneurysm in our case much larger, but also the site of the aneurysm was ostioproximal and atypical recurrent chest pain was the key finding.…”

Left Main Coronary Artery Aneurysm With Rare Quadfurcation Anatomy

“…The two most common modalities for coronary ectasia and aneurysm diagnosis are coronary angiography and coronary CTA [ 14 ]. Coronary angiography paired with intravascular ultrasound (IVUS) provides a better understanding of vessel wall structure.…”

“…Patch repair of the LM aneurysm enables future access of the coronary tree. Pericardial patch, internal thoracic artery and saphenous veins can be used for repair of the aneurysm [ 14 ]. A hybrid technique using percutaneous coronary intervention (PCI) and a surgical treatment has also been described [ 16 ].…”

Giant right coronary artery aneurysm mimicking a right intra-ventricular mass: a case report

“…Surgery is recommended in the cases with the risk of thrombosis or rupture, especially for cases of giant aneurysms. Surgical resection with bypass surgery is the most frequently chosen and accepted treatment for coronary artery aneurysm [11]. However, the best treatment strategy is still controversial.…”