A case of giant coronary artery aneurysm and literature review

Abstract

A 40-year-old man was referred to our hospital because of an abnormal shadow on the left cardiac border on the chest roentgenogram at the regular medical health examination without any symptoms. A giant coronary artery aneurysm of left anterior descending artery with a maximum diameter of approximately 50 mm was detected with computed tomography and coronary angiography. The patient was treated and followed up medically. Four years later, the size of the coronary artery aneurysm became larger. Then resection of the coronary artery aneurysm and coronary artery bypass grafting were successfully performed. Coronary artery aneurysms are rare in adults and are usually found in association with Kawasaki disease, coronary atherosclerosis, and so on. We also review the literature of giant coronary artery aneurysms exceeding 50 mm in diameter.

Asymptomatic Progression of an Atherosclerotic Giant Right Coronary Artery Aneurysm Over 12 Years

“…Giant CAAs are more likely to be symptomatic than clinically silent; on 1 literature review of 14 cases with diameters >80 mm, 11 (79%) were symptomatic. 3 Interestingly, our patient did not develop any symptoms despite compression of the right atrium and the right ventricle by the giant CAA ( Figure 1A). Although untreated CAAs have been noted to result in ischemia, myocardial infarction, distal embolization attributable to thrombus formation within the CAA, calcification, fistula formation, and spontaneous rupture, the optimal management strategy for asymptomatic giant CAAs remains unknown.…”

“…3 The rate of growth of CAAs has not been described. In our patient, the diameter of the giant CAA doubled approximately every 6 years.…”

“…2 Despite paucity of data on the natural history and long-term outcomes of CAAs, progressive increase in size over time is 1 of the indications for intervention. 3 We report a case of asymptomatic progression of an atherosclerotic giant right CAA to a diameter of 82 mm, occurring over a period of 12 years.…”

Giant aneurysm of circumflex coronary artery in asymptomatic patient

“…1 This finding is usually occasional (generally during cardiac catheterization) and it is reported in 1.1-4.9% of coronary angiography and 1.4% of autopsies, with preference for male gender (2.2% versus 1.5% in female gender) and right coronary artery (40-61% versus 15-32% in left anterior descending coronary artery, 15-23% in circumflex coronary artery and 0.1% in left main coronary artery). [2][3][4][5][6] Some authors classify aneurysms only on the basis of the shape, making difference between diffuse aneurysmal ectasia (that interests a large part of the coronary vessel) and discrete aneurysm (which is a localized abnormal dilatation with a spherical or saccular shape); other authors classify aneurysms combining their appearance and the number of coronary vessels affected.…”

“…1,2,13,14 In adult population, atherosclerosis accounts for the majority of cases (at least 50%), followed by congenital diseases (20-30%) and Kawasaki disease (10-20%), while the latter is the leading cause for the young and in childhood. 1,3,14,15 Natural history and prognosis of CAA is largely unclear: some authors report no difference in outcome for patients with or without aneurysm; other authors consider CAA a variant of coronary artery disease with similar reduced overall 5-year survival.…”