Giant right coronary artery aneurysm with associated dissection: diagnosis and surgical management

Coronary artery aneurysms are defined as a focal dilatation exceeding 1.5 times the diameter of the adjacent normal segment. They are found in up to 5% of patients undergoing coronary angiography. Giant coronary artery aneurysms (GCAAs), typically defined as >20 mm in diameter, with an incidence of ⁓0.02%. We present the case of an 82-year-old female who underwent coronary artery bypass grafting due to a giant right coronary artery aneurysm measuring 85 mm, identified on preoperative contrast-enhanced computed tomography (CT). The patient exhibited symptoms consistent with pericardial irritation secondary to aneurysms size and was found to have significant right heart compression. Surgical intervention included opening and resection of the aneurysmal sac and bypassing the affected segment using a saphenous vein graft. Intraoperatively, it was discovered that the aneurysm wall was dissected, with a high risk of rupture. This case highlights the importance of timely recognition and surgical management of GCAAs.