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Ann Thorac Surg 2000;70:673
© 2000 The Society of Thoracic Surgeons

Images in cardiothoracic surgery

Intraseptal coronary aneurysm

Tokuo Koshino, MD, PhDa, Kiyofumi Morishita, MD, PhDa, Kanshi Komatsu, MD, PhDa, Tomio Abe, MD, PhDa

a Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan

Address reprint requests to Dr Koshino, Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, 060-8543 Japan
e-mail: tokuo{at}serpent.cc.sapmed.ac.jp

Intraseptal coronary aneurysm after cardiac operation is a very rare entity. Our patient was a 57-year-old woman. She had undergone open mitral commissurotomy 19 years ago and undergone remitral commissurotomy and tricuspid annuloplasty 5 years ago. During follow-up, abnormal flow in the intraventricular septum was detected on echocardiography.

Right coronary arteriograpy (Fig 1 A, B) and enhanced computed tomographic scan (Fig 2 C) showed an intraseptal coronary aneurysm. Ligation of the feeding artery to the aneurysm was performed through infracostal incision. In postoperative coronary arteriography, an intraseptal coronary aneurysm disappeared. The etiology of this condition seems to have been damage of the right coronary artery because of needle air evacuation from the left ventricle through the ventricular septum.



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