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.