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On-pump beating-heart technique for managing a ruptured left coronary artery aneurysm

Atsushi Hiromoto1, Shun-Ichiro Sakamoto1, Kenji Suzuki1

  • 1Department of Cardiovascular Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.

Interdisciplinary Cardiovascular and Thoracic Surgery
|May 10, 2023
PubMed

Insights

This case study highlights a novel surgical approach for a ruptured coronary artery aneurysm with a coronary-pulmonary artery fistula. An on-pump beating-heart technique proved effective in managing this rare cardiac emergency.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Case Reports

Background:

  • Coronary artery aneurysms are rare, and their rupture, especially when associated with coronary-pulmonary artery fistulas, presents a significant surgical challenge.
  • Ruptured coronary artery aneurysms can lead to life-threatening complications such as cardiac tamponade and hemodynamic instability.
  • The management of such complex cases requires careful consideration of surgical techniques to ensure patient safety and optimal outcomes.

Purpose of the Study:

  • To present a rare case of a ruptured left coronary artery aneurysm with a coronary-pulmonary artery fistula in an elderly patient.
  • To describe the successful surgical management of this complex cardiac condition.
  • To evaluate the efficacy of an on-pump beating-heart technique in managing ruptured coronary artery aneurysms with associated fistulas.

Main Methods:

  • A case report of an 86-year-old woman presenting with chest discomfort due to a ruptured left coronary artery aneurysm and coronary-pulmonary artery fistula.
  • Diagnostic workup included echocardiography, coronary angiography, and computed tomography to delineate the anatomy.
  • Surgical intervention was performed using an on-pump beating-heart technique with cardiopulmonary bypass, involving ligation of inflow and outflow vessels and aneurysm closure.

Main Results:

  • Echocardiography identified cardiac tamponade, necessitating pericardial effusion drainage.
  • Coronary angiography and CT confirmed a ruptured left coronary artery aneurysm originating from the left anterior descending artery and a coronary-pulmonary artery fistula.
  • The on-pump beating-heart technique facilitated pulmonary trunk decompression, aneurysm dissection, and vessel identification, leading to successful aneurysm closure without cardiac arrest.

Conclusions:

  • An on-pump beating-heart technique is a viable and effective strategy for managing ruptured coronary artery aneurysms associated with coronary-pulmonary artery fistulas.
  • This technique offers advantages in managing complex cardiac anatomy and hemodynamic instability during emergency surgery.
  • Careful surgical planning and execution are crucial for successful outcomes in these rare and challenging cardiovascular conditions.

Keywords:
Coronary artery aneurysmCoronary-pulmonary artery fistulaOn-pump beating-heart technique

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