Giant right coronary artery aneurysm
Safa Hoodeshenas1, Nikkole Weber2, Prabhakar Shantha Rajiah2
1Department of Radiology, Mayo Clinic, Rochester, US. Hoodeshenas.Safa@mayo.edu.
The International Journal of Cardiovascular Imaging
|October 9, 2025
Insights
Coronary artery fistulas can cause significant hemodynamic changes, leading to progressive dilation and rare aneurysms, particularly in the right coronary artery.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Imaging
Background:
- Coronary artery fistulas (CAFs) are abnormal connections between coronary arteries and cardiac chambers or vessels.
- CAFs can lead to altered blood flow dynamics, potentially causing coronary artery dilation and aneurysm formation.
- Giant aneurysms (exceeding 50 mm) are uncommon, with a predilection for the proximal right coronary artery.
Purpose of the Study:
- To investigate the clinical presentation and management of coronary artery fistulas.
- To analyze the factors contributing to the development of coronary artery aneurysms in patients with CAFs.
- To review the literature on exceptionally large coronary artery aneurysms.
Main Methods:
- Literature review of case reports and series focusing on coronary artery fistulas and aneurysms.
- Analysis of hemodynamic alterations associated with different types of coronary artery fistulas.
- Review of imaging modalities used for diagnosing and characterizing coronary artery aneurysms.
Main Results:
- Coronary artery fistulas can cause significant hemodynamic disturbances.
- Progressive dilation and aneurysm development are potential complications of shunting into low-pressure areas.
- Giant aneurysms (>50 mm) are rare, most frequently involving the proximal right coronary artery.
Conclusions:
- Coronary artery fistulas require careful evaluation due to potential hemodynamic consequences.
- Early recognition and management are crucial to prevent complications like aneurysm formation.
- Giant coronary artery aneurysms represent a rare but serious manifestation of coronary artery fistulas.
Abstract:
Coronary artery fistulas can markedly alter hemodynamics and predispose patients to a range of complications. Shunting into low-pressure structures may drive progressive coronary artery dilation and, in some cases, aneurysm development. Aneurysms exceeding 50 mm are exceptionally rare and are most often reported in the proximal right coronary artery.
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