Ann Thorac Surg 2008;85:1106. doi:10.1016/j.athoracsur.2007.06.041
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Giant Right Coronary Artery Aneurysm Associated With Bilateral Coronary Artery to Pulmonary Artery Fistula
Sak Lee, MD,
Gijong Yi, MD,
Young-Nam Youn, MD,
Suk-Won Song, MD,
Do-Kyun Kim, MD,
Byung-Chul Chang, MD*
Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea
* Address correspondence to Dr Chang, 134 Shinchon-dong, Seodaemoon-gu, Seoul, 120-752, Republic of Korea. (Email: bcchang{at}yumc.yonsei.ac.kr).
A 75-year-old woman presented with progressive chest discomfort. She had not experienced any chest trauma or thoracic surgery. Her chest x-ray film showed cardiomegaly with a bulging contour at right hilar area suspicious of anterior mediastinal mass (Fig 1). Echocardiography revealed a huge, round-shaped, cyst-like mass with partial right atrial collapse due to the compression of the mass with normal global left ventricular systolic function. Contrast echocardiography showed filling of dye within the mass after perfluorocarbon exposed sonicated dextrose albumin infusion. Multi-slice computed tomography showed a 8.5-cm sized huge intrapericardial aneurysm in the right atrioventricular groove that received blood from the mid-right coronary artery, which drained into the main pulmonary artery (Fig 2). Cited in Figure 2, the cubes in the lower right corner represent the orientation (F = feet; H = head; R = right). Coronary angiography provided confirmation of mid-right coronary artery aneurysm, showed multiple varicosities involving the left anterior descending artery associated with bilateral coronary artery to the main pulmonary artery fistula.
The patient underwent surgical resection of the aneurysm for decompression, repair of the fistulous tract from the mid-right coronary artery to the aneurysm, and surgical coronary artery bypass grafting from the left internal mammary artery to the distal left anterior descending artery, and repair of the aorta to the distal right coronary artery using a saphenous vein graft. Some of the left coronary artery to the main pulmonary artery fistulas were ligated externally. A postoperative multi-slice computed tomographic scan showed a reduction in the size of the aneurysm without residual communication with the mid-right coronary artery, and patent left internal mammary artery, saphenous vein grafts, and a residual left coronary artery to the main pulmonary artery fistulas (Fig 3). The patient’s postoperative course was uneventful. He was discharged 2 weeks after surgery without residual clinical symptoms.
