Multiple giant coronary artery aneurysms combined with right coronary artery-pulmonary artery fistula: a case report

Abstract

Background The combination of multiple giant coronary artery aneurysms (CAAs) and right coronary artery (RCA) to pulmonary artery (PA) fistula is extremely rare and the patients with CAAs may suffer from several fatal complications. We herein describe a 60-year-old female with hemodynamic instability who was diagnosed with multiple giant CAAs combined with RCA-PA fistula. Case presentation The patient, a 60-year-old female, presented to the emergency room because of progressive exertional chest distress and fatigue. The transthoracic echocardiography (TTE), coronary computed tomography angiography (CTA) and invasive coronary angiography confirmed the existence of multiple giant CAAs and RCA-PA fistula. Laboratory examinations for systemic vasculitis and infectious diseases demonstrated no abnormalities and work-up for childhood and family history were negative. We have performed a successful surgical treatment for this patient. The patient’s restrictive cardiac dysfunction was improved after debriding the advanced thrombi in aneurysm sac and ligating the fistulous vessel between the native RCA and PA. The postoperative pathologic examination of the aneurysmal wall revealed loss of smooth muscle cells in the media with local mucoid degeneration, no chronic inflammation, sclerosis and IgG4 were observed. Conclusions The treatment decision-making process should depend upon the patients’ specific situations. Our case suggests the surgical intervention should be accepted as the preferred treatment for giant CAAs with restrictive cardiac dysfunction. Electronic supplementary material The online version of this article (10.1186/s12893-019-0547-z) contains supplementary material, which is available to authorized users.

A rare case of sudden death due to IgG4‐related giant coronary artery aneurysms

“…This was surprising as there is a drastic increase in the size of the aneurysms over a short period of time (few months). This was also much larger than reported sizes of CAA, which measured between 11 and 46 mm [17,18,21]. In addition, there appeared to be resolution of the previously documented peri‐arterial masses.…”

“…One refers to dilatation that is more than 4 times the diameter of a reference vessel while another indicates that they are more than 4 cm in diameter [16]. In a study based on patients undergoing coronary artery angiography, the incidence of CAA was 0.3%-5% [17], and the estimated incidence of giant CAA is 0.02% [18]. It should be highlighted that there are several causes of CAA.…”

The evaluation of the coronary arteries calcification degree by the method of cardiovascular MSCT in patients with vitamin D and homocysteine metabolism disturbance

“…The density factor is calculated by the peak density of the calcification zone, which is expressed in Hounsfield units (HU). The coronary artery calcinosis (CAC) is defined as an area with a density greater than 130 HU [7][8][9][10].…”

Two genetic variants in NEXN and ABCC6 genes found in a patient with right coronary artery to right ventricle fistula combined with giant coronary aneurysm and patent ductus arteriosus

“…The reported incidence of coronary aneurysms ranges from 0.3 to 5% in patients undergoing coronary angiography ( 7 ). Giant CAA are rare, with an estimated incidence of 0.02% ( 8 ). CAFs combined with giant CAA are rare, with an incidence of 5.9% among patients with CAFs ( 9 ).…”