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A challenging pacemaker implantation in the presence of a giant right coronary aneurysm compressing the right atrium

Stefano Maffè1, Paola Paffoni2, Luca Bergamasco3

  • 1Division of Cardiology, SS Trinita' Borgomanero Hospital, ASL NO, Novara. stemaffe@libero.it.

Monaldi Archives for Chest Disease = Archivio Monaldi Per Le Malattie Del Torace
|November 22, 2021
PubMed

Insights

Giant coronary artery aneurysms can complicate pacemaker implantation by compressing the right atrium. Echocardiography is crucial for guiding lead placement in these challenging cardiac device procedures.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Giant coronary artery aneurysms (GCAAs) are rare cardiovascular conditions.
  • Treatment options for GCAAs include surgical intervention and percutaneous coil embolization.
  • Thrombosed aneurysms can lead to extrinsic compression of cardiac chambers, potentially causing hemodynamic compromise.

Observation:

  • A patient with syncope, AV block, and bundle branch block presented with a large, thrombosed right coronary artery aneurysm (85x90 mm).
  • The aneurysm caused significant compression of the right atrium.
  • Pacemaker implantation was technically challenging due to the compressed right atrial anatomy.

Findings:

  • Successful pacemaker lead implantation was achieved using combined echocardiographic and fluoroscopic guidance.
  • This approach facilitated navigation through the compressed right atrium.

Implications:

  • This case highlights the critical role of echocardiography in managing complex cardiac device implantation in patients with GCAAs.
  • Advanced imaging guidance is essential for overcoming anatomical challenges posed by cardiac compression.
  • Effective management strategies are needed for patients with GCAAs requiring cardiac electronic devices.

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