Giant right coronary artery aneurysm- case report and literature review

Neerod K Jha,1Husam Z Ouda,2Javed A Khan,1Gregory P Eising,1 and Norbert Augustin1

Case presentation

A 54 years-old-hypertensive male patient was presented to us with history of recent inferior wall myocardial infarction (MI) which was managed with medical treatment in the referring hospital. On clinical examination, there was a 3/6 ejection systolic murmur along the left lower sternal border. Electrocardiogram was consistent with inferior MI. The 2-D echocardiogram revealed a large cystic mass adjacent to the right atrium. Coronary angiography revealed significant coronary artery disease in the proximal left anterior descending artery (LAD) and a giant aneurysm of middle segment of right coronary artery (RCA). There was a mild ectatic segment in the proximal circumflex coronary artery, as well.

Patient underwent successful resection of giant aneurysm of RCA under cardiopulmonary bypass (CPB) via median sternotomy. Proximal and distal communications of RCA were ligated from within the aneurysmal sac and then coronary artery bypass graft surgery (CABG) was performed using right internal mammary artery to the distal RCA and left internal mammary artery to the LAD.

The aneurysmal sac was found to be 12 × 9 × 1 cms in dimension, occupying the entire right atrioventricular groove and displacing the right atrium (Figure ​(Figure11 &2). There was no luminal thrombus or calcification. Histopathology of excised aneurysm had shown widespread myxoid degeneration in the media, focal necrosis, atherosclerosis and fibrosis of the medial muscles.

Figure 1
Operative photograph showing a giant aneurysm of the right coronary artery.
Figure 2
Operative photograph showing inside view of the aneurysmal sac. The tip of probe is within the proximal communication of right coronary artery.