Rare Case of Giant Asymptomatic Left Coronary Artery Aneurysm of 10 cm Associated with Coronary Cameral Fistula

Abstract

A giant coronary artery aneurysm (CAA) associated with a coronary cameral fistula is an extremely rare finding. Most cases of CAAs are asymptomatic. The incidence of CAA varies between 0.3% to 5.3%. Due to advancements in diagnostic technologies, the incidence of CAA is on the rise. Even in the modern days of medical science, the clinical course of CAA is still unpredictable and the suitable timing for the treatment of CAA is still open to debate. We reported a case of a giant coronary artery aneurysm in a 38-year-old female, which was 9.4 x 9.7 x 9.2cm in size, arising from the left coronary artery, extending into the proximal circumflex, and draining into the right atrium, forming a fistula tract. The patient was diagnosed with the help of coronary computed tomography (CT) and cardiac catheterization after which surgery was performed to repair the aneurysm and fistula. Postoperatively, the patient recovered without any complication.

Transcatheter closure of a large coronary cameral fistula presenting as a calcified cystic right atrial mass

“…There are few case reports detailing aneurysm formation of cardiac or extracardiac structures from coronary cameral fistulas, but none to our knowledge of a fully calcified right atrial structure leading to right heart dysfunction. 10,11 While the use of echocardiography led to functional understanding of the mass, the high spatial resolution of cardiac CT was required to help understand the complex anatomical structure and aided in preprocedural planning. 12 The exit point of the fistula into this mass was associated with the superior vena cava/right atrial junction.…”

Right Coronary Artery-to-Right Atrial Fistula Accompanied by Multiple Right Coronary Artery Aneurysms: A Case Report

“…The pathogenesis underlying both CAA and CAF remains subject to debate, although their etiologies are believed to encompass congenital and acquired factors. CAA predominantly arises from atherosclerotic processes in adults; however, it can also manifest in the context of congenital heart defects, Kawasaki disease, vasculitides (such as Takayasu arteritis and polyarteritis nodosa), as well as certain autoimmune disorders (e.g., scleroderma and systemic lupus erythematosus) [ 5 ]. Conversely, CAF primarily stems from traumatic events (such as gunshot wounds or stab injuries) or iatrogenically through interventional cardiac procedures [ 6 ].…”

Giant Sinoatrial Nodal Artery Aneurysm with Fistula into the Right Atrium Treated by Partial Resection and Plication: A Case Report

“…Giant CAAs are a rare entity predominantly found in adults over the age of 60 years and are slightly more common in males than in females. 2 , 4 Small CAAs are often asymptomatic and may not require resection, whereas giant CAAs produce symptoms. 8 Dyspnea, chest pain, and palpitations are the common symptoms of giant CAAs.…”

“… 1 Because of the rising trend in interventional techniques, the incidence of CAAs is rising. 2 CAAs usually involve a single vessel, whereas rarely do they involve more than 1 vessel. 3 The right coronary artery (RCA) is the most commonly involved vessel in CAAs.…”