Heart Transplantation in Nonoperable Multiple Giant Coronary Artery Aneurysms: A Case Report

Coronary artery aneurysm (CAA) is an uncommon dilation of a coronary artery, with a prevalence of 0.3%-4.9% in patients undergoing coronary angiography. Giant CAAs, defined as dilations greater than four times the size of normal adjacent vessels or a diameter > 8 mm, are even rarer. We report a case of a 62-year-old man with chronic ischemic heart disease presenting with multiple giant CAAs. The patient had a history of myocardial infarction, obesity, dyslipidemia, and was an ex-smoker. Coronary angiography and cCTA revealed giant aneurysms in the right coronary and circumflex arteries, with extensive endoluminal thrombosis and compression of adjacent structures. The coronary anatomy was deemed unsuitable for surgical or percutaneous intervention; thus, the patient was listed and underwent orthotopic heart transplantation, without significant postoperative complications. This case highlights the complexity of giant CAAs management in adults, where conventional interventions are not feasible. The successful heart transplantation and favorable postoperative outcomes underscore the potential viability of this treatment. This case contributes to the limited literature on heart transplantation as a therapeutic option for nonoperable CAAs.