False aneurysm of the left coronary artery

The case of a 65-year-old white man with a large false aneurysm of the left coronary artery resulting from spontaneous rupture of the circumflex coronary artery is described. An abnormal chest roentgenogram resulted in initial evaluation, and a coronary aneurysm was then suspected on the basis of two-dimensional echocardiography. Cardiac catheterization demonstrated a large, saccular false aneurysm arising from the left coronary artery and diffuse aneurysmal disease of the right coronary artery. The patient underwent surgical resection of the aneurysm and saphenous vein aorta-coronary bypass grafting but failed to survive the postoperative period. Pathological examination documented histologic proof of a false aneurysm. The optimal treatment for coronary artery aneurysms is unknown but must be based on symptomatic associated arteriosclerotic heart disease and the risks of complications related to the aneurysm, including the risk of rupture with formation of a false aneurysm as documented in this case.