[A case report of surgical treatment of ruptured coronary artery aneurysm]
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F Yamaki1, M Nakajima, T Hirayama
1Department of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Japan.
Insights
A ruptured coronary artery aneurysm, a rare complication of coronary artery fistula, led to acute heart failure in a 63-year-old woman. Surgical intervention successfully treated this life-threatening condition, highlighting the importance of timely management for such rare cardiac emergencies.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Coronary artery fistulas (CAFs) are abnormal connections between a coronary artery and a cardiac chamber or another vessel.
- While often asymptomatic, CAFs can lead to serious complications such as aneurysm formation, rupture, heart failure, and myocardial infarction.
Observation:
- A 63-year-old female presented with acute heart failure secondary to a ruptured coronary artery aneurysm.
- The aneurysm originated from the left anterior descending artery and was associated with a coronary artery fistula.
- Intraoperative findings revealed a large pericardial effusion with hemorrhagic fluid and a 50 mm-diameter aneurysm with perforation.
Findings:
- Surgical management involved closure of the fistula and aneurysmectomy under extracorporeal circulation.
- The patient experienced an uneventful postoperative recovery.
Implications:
- Ruptured coronary artery aneurysms, though rare, represent a critical surgical emergency.
- This case underscores the high-risk nature of coronary artery aneurysms associated with fistulas and the necessity of surgical intervention.
- Prompt diagnosis and surgical repair are crucial for managing these potentially fatal cardiovascular events.
Abstract:
A 63-year-old women experienced acute heart failure due to a ruptured aneurysm resulting from the coronary artery fistula which originated from the left anterior descending artery. On surgery, the pericardial cavity was found filled with massive hemorrhagic fluid and perforation was detected on the surface of the aneurysm, sphere-shaped with a approximate diameter of 50 mm. Operation was done by closure of fistula and subsequent aneurysmectomy under extracorporeal circulation. Post operative course had been uneventful. Coronary artery fistula accompanied with aneurysm had been thought to have a high risk of rupture and to be in indication of surgical intervention. This case report was undertaken with bibliographical consideration, since there had been only a few reports of actual ruptures.