Giant Circumflex Aneurysm With Arteriovenous Fistula Surgery Guided by Three-Dimensional Printing

A giant coronary artery aneurysm is an infrequent anomaly encountered as an incidental finding. An even more rare condition is its association with a coronary artery fistula. We report the case of a 61-year-old woman that combines two of the rarest coronary anomalies: a 70-mm giant circumflex aneurysm with an arteriovenous fistula tract draining to the superior vena cava. Considering the unique display of anatomy, the surgery was guided with 3-dimensional printing technology. Direct fistula occlusion near its outflow union, orifice source closure, aneurysmal sac exclusion, and two coronary artery bypass grafts were surgically performed. The postoperative course was satisfactory.