Conservative Management of Giant Aneurysm of the Left Main to Left Circumflex Arteries
Amine Mamoun Boutaleb1, Cyrille Boulogne1, Pierre Chenard1
1Department of Cardiology, Dupuytren University Hospital, Limoges, France.
Insights
Giant coronary artery aneurysms (CAA) can be managed conservatively in asymptomatic patients, with multimodal imaging crucial for diagnosis and surveillance. This case highlights a successful conservative approach for a giant CAA with mitral regurgitation.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary artery aneurysm (CAA) is a rare coronary malformation, often asymptomatic and occasionally associated with coronary artery fistula (CAF).
- Giant CAAs, particularly those involving major coronary arteries, present unique management challenges due to their rarity and potential for complications.
Background:
Coronary artery aneurysm (CAA) is a rare congenital or acquired coronary malformation, associated with coronary artery fistula (CAF) in approximately 15% of cases. CAA is often asymptomatic.
Case Summary:
We report the case of a 60-year-old woman diagnosed in 2017 with a 15-mm large giant left main to left circumflex CAA. In 2024, she presented with progressive dyspnea. Multimodality imaging revealed severe mitral valve regurgitation and giant CAA associated with a distal CAF. After comprehensive evaluation, the heart team opted for mitral valve surgery and conservative CAA management. After 9-month follow-up, she remains uneventful.
Discussion:
Management of giant CAA is controversial. Surgery remains the gold standard treatment, yet particularly challenging. It is mainly recommended for symptomatic patients, with evidence of ischemia or a significant left-to-right shunt.
Take-Home Messages:
Conservative therapy remains a valuable option in asymptomatic cases, provided that close follow-up is ensured. Multimodal imaging is crucial for diagnosis, management, and surveillance.
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