Giant Coronary Artery Aneurysms With Coronary Sinus Fistula: Forget the Distal Bypass

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Vascular Medicine

Background:

• Coronary artery aneurysms with coronary sinus fistulas are rare conditions presenting significant surgical challenges.
• Traditional management often involves complex procedures like ligation with distal bypass due to concerns about rupture and hemodynamic compromise.

Observation:

• Two symptomatic patients with coronary artery aneurysms and coronary sinus fistulas were surgically managed.
• One patient presented electively due to concerns of aneurysmal growth and rupture.
• The second patient presented with cardiogenic shock secondary to excessive shunting and right heart failure.

Findings:

• A successful surgical approach using ligation alone was performed in both patients.
• This outcome was attributed to the presence of significant collateral circulation in the adult patients.
• Ligation alone proved effective, obviating the need for distal bypass surgery.

Implications:

• This case series suggests that ligation alone is a viable and effective treatment for coronary artery aneurysms with coronary sinus fistulas in adults.
• The findings highlight the importance of assessing collateral circulation in surgical planning.
• This simplified approach may reduce surgical complexity and improve patient outcomes for this rare pathology.