Left circumflex artery aneurysm with fistula to the coronary sinus

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Pathology

Background:

• Giant coronary artery aneurysms (GCAAs) are rare, often asymptomatic, but can cause significant morbidity.
• Arteriovenous fistulas (AVFs) involving the coronary arteries and cardiac chambers are exceptionally uncommon.
• Surgical management of complex GCAAs with AVFs presents unique challenges.

Observation:

• An 82-year-old female presented with symptoms attributed to a giant left circumflex artery aneurysm.
• The aneurysm extended from the left main coronary artery to a fistula draining into the coronary sinus.
• Imaging revealed significant dilation of the left coronary artery and the presence of the arteriovenous fistula.

Findings:

• Surgical intervention was performed to address the symptomatic giant coronary artery aneurysm and arteriovenous fistula.
• The surgical strategy included direct closure of the fistula and exclusion of the aneurysmal segments.
• Coronary artery bypass grafting was necessary for all branches originating from the aneurysmal portion.

Implications:

• This case highlights a successful surgical approach for a rare and complex cardiovascular pathology.
• The findings contribute to the limited surgical literature on giant coronary artery aneurysms with arteriovenous fistulas.
• Effective management strategies can be developed for similar complex coronary artery pathologies.