Distal Left Main Coronary Artery Aneurysm in the Absence of Coronary Artery Disease

Left main coronary artery (LMCA) aneurysms are exceedingly rare and most commonly associated with coronary artery disease.

We report the case of a 70-year-old man with frequent runs of nonsustained ventricular tachycardia who was found to have a distal LMCA aneurysm without significant coronary artery disease. He was managed medically because of complex anatomy and minimal symptom burden.

LMCA aneurysms are typically discovered incidentally during ischemic evaluation in association with hemodynamically significant coronary artery disease with reports often noting concomitant critical stenoses. Management in this case was complicated by involvement of the left main trifurcation. This patient's autoimmune neuromuscular disease and glucocorticoid exposure may have contributed to aneurysm formation.

Symptom burden is an important consideration in management decisions even in cases of giant LMCA aneurysms particularly if they are located distally. Blood pressure and heart rate regulation as well as serial imaging may be appropriate in certain cases.