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Coronary Artery Fistula Aneurysm: Pathological Analysis After Surgery
Atsuo Mori1, Shinya Inoue2, Hideki Orikasa3
1Cardiovascular Surgery, Kawasaki Municipal Hospital, Kawasaki, JPN.
Cureus
|June 11, 2021
Summary
A large coronary artery fistula aneurysm was found in an asymptomatic woman. Surgical resection and bypass grafting were successful, with pathology suggesting medial depletion similar to SAM may be involved.
Area of Science:
- Cardiovascular Surgery
- Radiology
- Pathology
Background:
- Coronary artery fistulas (CAFs) are rare congenital or acquired abnormal connections between a coronary artery and a cardiac chamber or great vessel.
- Aneurysms within CAFs are even rarer and can pose significant risks if not managed appropriately.
Observation:
- A 75-year-old asymptomatic woman presented with a 40-mm round lesion adjacent to the pulmonary artery on CT scan.
- Coronary angiography revealed a coronary artery fistula aneurysm (CAFA) originating from the left anterior descending artery and extending towards the pulmonary artery.
Findings:
- The CAFA was successfully resected, and coronary artery bypass graft surgery was performed using the left internal thoracic artery.
- Pathological examination indicated medial depletion, a characteristic feature seen in segmental arterial mediolysis (SAM), as a potential contributor to aneurysm formation.
Implications:
- This case highlights the importance of advanced imaging in detecting rare cardiovascular anomalies.
- The findings suggest a potential link between medial abnormalities, such as those seen in SAM, and the development of coronary artery fistula aneurysms.
- Successful surgical management underscores the feasibility of treating large CAFA with complex anatomy.
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