Case study: coronary aneurysm
This article highlights the case of a 64-year-old man with a history of obesity diagnosed with a giant coronary artery coronary aneurysm (GCAA). The patient was referred to the cardiovascular clinic with symptoms of exertional dyspnoea and chest pain. His medical history was significant for benign prostate hypertrophy, also known as prostate gland enlargement commonly seen in older men and opium addiction. On presentation, his weight was 151 kg with a body mass index of 46.
Doctors advised a coronary angiography which showed a giant aneurysm, originating from the left anterior descending artery (LAD). Treatment included surgery. Surgery confirmed the presence of a clot-filled coronary aneurysm originating from the LAD. The aneurysm was also seen compressing the pulmonary artery. In addition, the aneurysm was measured to be about 42 mm with several orifices opening to the left main coronary artery, LAD and left circumflex artery.
During treatment, the floor of the aneurysm and orifices were kept, whereas other parts of the aneurysm were excised. Similarly, a coronary artery bypass graft (CABG) was done after aneurysmectom using the radial artery to the LAD. After the procedure flowmetry was done which showed good flow in the LAD.
The patient had an uneventful recovery and was discharged from the hospital.
GCAA is a rare disease commonly caused because of coronary atherosclerosis. In most cases, patients are asymptomatic and the aneurysm may be found incidentally in the coronary angiography. However, in symptomatic patients, common symptoms include palpitations, dyspnoea and chest pain with the right coronary artery most commonly involved. Patients with the condition may also experience sudden death because of myocardial infarction or complications of ischaemia. Currently there is no standard surgical approach for GCAA and further studies are needed to standardize a treatment approach.
Source: American Journal of Case Reports
