Giant coronary artery aneurysm at autopsy

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Pathology

Background:

• Coronary artery aneurysms are rare, often asymptomatic vascular dilatations.
• Aneurysms can lead to serious complications including rupture, thrombosis, and myocardial infarction.
• Early diagnosis and management are crucial for preventing adverse outcomes.

Observation:

• A 20-year-old woman presented with sudden chest pain and died.
• She had a history of a large blood-filled sac compressing the left atrium and ventricle, identified during pregnancy.
• Imaging revealed aneurysmal dilatation of the left main coronary artery.

Findings:

• Autopsy revealed a massive left coronary artery aneurysm (10.0x9.0 cm) with a 7.0 cm rupture.
• The pericardial sac contained 900 mL of blood and clots, indicating cardiac tamponade.
• The rupture of the coronary artery aneurysm was the direct cause of death.

Implications:

• This case underscores the potentially catastrophic consequences of unmonitored coronary artery aneurysms.
• It highlights the importance of comprehensive cardiovascular evaluation, especially in pregnant women with cardiac findings.
• Prompt surgical intervention or close monitoring may be necessary for managing coronary artery aneurysms to prevent fatal rupture.