A Huge Coronary Aneurysm Resulting from a Coronary Artery-to-Left Ventricle Fistula.

Abstract

Ahuge coronary aneurysm resulting from a coronary artery-to-left ventricle fistula is a rare condition. A 57-year-old male had severe recurrent angina attacks. The cause of angina pectoris was a right coronary artery-to-left ventricle fistula with a huge coronary aneurysm. The histological examination of surgically excised specimens revealed that two vertical smooth muscle layers of media of the aneurysmmight be associated with dysplasia. Mucoiddegeneration wasalso shown in the intima and around the vasa-vasorum. Abnormalhemodynamicsrelated to the fistula might have induced these vessel wall changes resulting in the huge coronary aneurysm.

Right Coronary Artery Aneurysm With Fistula to Left Ventricle

“…4 Coronary artery to right ventricle fistula has often been diagnosed by findings of continuous heart murmur, but in many cases of coronary artery LV fistula, only to-and-fro murmur can be heard, 5 as in the present patient. If shunt volume increases, left sided heart failure may appear due to volume load; and even in low shunt volume, the steal phenomenon of the coronary artery may occur and cause myocardial ischemia in patients with advanced coronary artery fistula.…”

Right Coronary Artery Fistula to Left Ventricle Complicated with Huge Coronary Artery Aneurysm

“…This aneurysm is regarded as one of the complications of CAF, where the RCA communicates with the left ventricle, as published in a few English language reports (13,14). Most of the patients with CAF older than 20 years, although they may remain asymptomatic as in this case, develop symptoms, like angina pectoris (14,15) and infective endocarditis (16), with fistula-related complications with increasing age. Mortality and morbidity is hence increased when surgery is performed in later life (17).…”

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.…”