Korean Circ J.  2013 Feb;43(2):127-131. 10.4070/kcj.2013.43.2.127.

Saccular Coronary Artery Aneurysm and Fistula with Organized Thrombi

• Jeong EH
• Kim BJ
• Bang KB
• So MS
• Sung KC
• Kim JT
• Kong JH
• Kim TH

• KMID: 1769650
• DOI: http://doi.org/10.4070/kcj.2013.43.2.127

Abstract

Saccular coronary artery aneurysm, associated with coronary artery fistula, is a very rare condition. A 48-year-old woman was referred to our hospital for the evaluation of an abnormal shadow on the left cardiac border from a chest X-ray film during regular medical health examination. A huge saccular aneurysm with organized thrombi in the proximal left anterior descending artery (LAD) and coronary artery fistulae from LAD and conus branch of the right coronary artery to pulmonary artery was diagnosed by transthoracic echocardiography, multi-detector computer tomography (MDCT), and coronary angiography. The patient received surgical treatment, including thrombectomy of aneurysm, ligation of the inlet and outlet of aneurysmal sac, coronary artery bypass graft (left internal mammary artery-to-distal LAD), and ligation of fistulae. The postoperative course was uneventful, and postoperative echocardiography and MDCT revealed patent bypass graft; however, a small fistula from proximal LAD across aneurysmal sac to pulmonary artery was observed.

Keyword

Coronary aneurysm; Coronary vessels, arterio-arterial fistula

MeSH Terms

Aneurysm
Arteries
Coronary Aneurysm
Coronary Angiography
Coronary Artery Bypass
Coronary Vessels
Echocardiography
Female
Fistula
Humans
Ligation
Pulmonary Artery
Thorax
Thrombectomy
Transplants
X-Ray Film

Figure

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  Fig. 1 The chest radiography of the patient shows abnormal heart shadow (arrow).

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  Fig. 2 The parasternal short axis view of transthoracic echocardiography. A: aneurysmal sac (arrow) filled with thrombus, size about 4.1×4.0 cm. B: fistula from aneurysmal sac to pulmonary the artery (color flow) and aneurysmal sac (arrow). Ao: aorta, LA: left atrium, MV: mitral valve, PA: pulmonary artery, RV: right ventricle.

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  Fig. 3 Multi-detector computed tomography of the coronary artery. A: reconstructed image shows saccular aneurysm (arrow) of LAD with fistula (arrowhead) from the conus artery to pulmonary artery. B: LAD (arrowhead) and aneurysmal sac (arrow). LAD: left anterior descending artery.

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  Fig. 4 Coronary angiography. A: right coronary artery (arrowhead) and a fistula (arrow) from the conus artery to pulmonary artery (short thin aorrw). B: left anterior descending artery (arrowhead), aneurysmal sac (arrow), fistula (long thin arrow) from proximal LAD to pulmonary artery (short thin arrow). LAD: left anterior descending artery.

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  Fig. 5 Operative photograph. A: a fistula from the conus artery to pulmonary artery (arrow). B: aneurysmal sac. C: aneurysmal sac filled with thrombus. D: a fistula opening (arrow) at pulmonary artery.

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  Fig. 6 Postoperative evaluation. A: coronary artery CT shows ligation sites. a: conus artery fistula ligation, b: LAD aneurysm proximal ligation, c: LAD aneurysm distal ligation. B: echocardiography shows remnant fistula. a: pulmonary valve. PA: pulmonary artery, Ao: aorta, LA: left atrium, LAD: left anterior descending artery.

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