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Surgical management of arteriosclerotic coronary artery aneurysm
T Shimizu1, T Hirayama, N Koizumi
1Department of Surgery II, Tokyo Medical University, Japan.
Insights
A large saccular right coronary artery aneurysm was successfully ligated, but gastroepiploic artery grafting proved problematic due to diffuse coronary ectasia, highlighting potential bypass conduit limitations.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- A 60-year-old male with a history of myocardial infarction presented with a large saccular right coronary artery aneurysm.
- Coronary angiography revealed total left anterior descending artery occlusion and significant ectasia adjacent to the aneurysm.
Observation:
- The aneurysm thrombosed and caused distal coronary artery stenosis despite anticoagulant therapy.
- Surgical intervention involved aneurysm ligation and in situ gastroepiploic artery grafting.
Findings:
- The patient developed sudden heart failure, attributed to graft hypoperfusion, necessitating supplemental saphenous vein grafting.
- Ligation effectively managed the aneurysm, but the gastroepiploic artery was an unsuitable conduit for the ectatic vessel.
Implications:
- Ligation is a viable strategy for managing large saccular coronary artery aneurysms.
- Diffuse coronary ectasia can compromise the patency and suitability of gastroepiploic artery grafts in bypass surgery.
Abstract:
A 60-year-old man suffered antero-septal myocardial infarction at the age of 56. Coronary angiography demonstrated total occlusion of the left anterior descending artery and a large saccular aneurysm of the right coronary artery. Diffuse coronary ectasia was also shown in the right coronary artery adjacent to the aneurysm. Despite anticoagulant therapy, the aneurysm formed a thrombus and developed coronary artery stenosis distal to the aneurysm. Ligation of the aneurysm and in situ gastroepiploic artery grafting were performed. Sudden heart failure was developed during skin closure. As this condition was considered to be graft hypoperfusion, supplemental saphenous vein grafting was placed. Ligation is a simple, reliable technique to prevent future complications for a large saccular right coronary artery aneurysm, however, gastroepiploic artery might be an inappropriate bypass conduit for the ligated coronary artery with diffuse ectasia.