Heart Transplantation in Nonoperable Multiple Giant Coronary Artery Aneurysms: A Case Report
Raffaele Abete1, Roberta Simona Cattaneo2, Attilio Iacovoni1
1Department of Transplant Surgery and Surgical Treatment of Heart Failure, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.
Insights
Giant coronary artery aneurysms (CAAs) are rare, often requiring complex management. Heart transplantation proved a viable option for a patient with multiple giant CAAs unsuitable for conventional treatment.
Area of Science:
- Cardiology
- Vascular Surgery
- Transplantation Medicine
Background:
- Coronary artery aneurysm (CAA) is an uncommon dilation of coronary arteries.
- Giant CAAs (>8mm diameter or >4x normal size) are exceptionally rare.
- Management of giant CAAs is challenging, especially in adults.
Purpose of the Study:
- To report a rare case of multiple giant coronary artery aneurysms in an adult patient.
- To discuss the management challenges and treatment options for non-operable giant CAAs.
- To highlight orthotopic heart transplantation as a potential therapeutic strategy.
Main Methods:
- Case report of a 62-year-old male with chronic ischemic heart disease.
- Diagnostic workup included coronary angiography and computed tomography angiography (cCTA).
- Patient underwent orthotopic heart transplantation due to inoperable coronary anatomy.
Main Results:
- The patient presented with multiple giant aneurysms in the right coronary and circumflex arteries.
- Extensive endoluminal thrombosis and compression of adjacent structures were noted.
- The patient had a successful heart transplantation with no significant postoperative complications.
Conclusions:
- Giant CAAs pose significant management challenges, often precluding conventional interventions.
- Orthotopic heart transplantation can be a successful therapeutic option for selected patients with non-operable giant CAAs.
- This case contributes valuable insights into the limited literature on heart transplantation for complex coronary artery pathologies.
Abstract:
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.
