Discussion
Giant coronary artery aneurysms (CAA) are exceedingly rare, and multiple
imaging modalities are often performed to obtain the correct diagnosis
and aid preoperative planning. (3) They are typically associated with
atherosclerosis but can be seen in patients with familial aortopathy or
autoimmune disorders. Our patient did not have any personal or family
risk factors and imaging characteristics in this case favored congenital
etiology. Coronary angiography, which continues to be a gold standard
for coronary imaging, may not provide all the information necessary in
this setting because of selective propagation of the dye into the CAA as
opposed to highlighting the terminal vessel. Coronary CTAs can be
invaluable evaluate the distal coronary artery as a potential target for
bypass. While the absolute risk of adverse events is unknown,
development of myocardial infarction and coronary rupture is described
and thus semi-urgent surgical intervention in this stable patient was
favored. In young patients, coronary aneurysms are most often
encountered as sequelae of Kawasaki’s disease, in which subsequent
surgical intervention with CABG represents a more favorable outcome
compared to PCI (4). They are predominantly encountered in the RCA.
Surgical approaches described vary, and include both patch repair and
IMA bypass. This particular report is unique in multiple ways. First, a
coronary artery aneurysm of considerable size was incidentally found in
a healthy young adult. Second, this giant aneurysm involved the LAD, and
multiple imaging modalities were important to help characterize its
extent and anatomic involvement. Lastly, this is the first report that
we know of in which the size of the aneurysm precluded distal
revascularization via bypass grafting. Extensive workup and
understanding of the anomaly allowed for complete surgical excision and
favorable outcome.
Author Contributions: Resident RD was involved in initial
inpatient workup and contributed to the manuscript with assistance from
resident LE. OO was the attending surgeon during initial presentation
and facilitated the patient’s workup and subsequent diagnosis. IS was
attending surgeon for the operation. AK assisted with workup and
operative planning. All authors contributed to edits and revisions and
approved the final submitted manuscript.