IMAGES IN CARDIAC SURGERY
Surgery of giant right coronary artery aneurysm complicated
with coronary artery fistula to left ventricle
Takeshi Uzuka PhD
Masanori Nakamura PhD
Tomohiro Nakajima PhD
Noriyasu Watanabe PhD
Yuichiro Fukazawa PhD
Department of Cardiovascular Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
Department of Surgical Pathology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
Takeshi Uzuka PhD, Department of Cardiovascular Surgery, Sapporo City General Hospital, 060-8604 Sapporo, Japan.
Coronary artery aneurysms (CAA) may exceed 5 cm,
the right coronary artery (RCA),
may occur in close proximity to the left
and may result in pulmonary artery fistulae
or compress the
right atrium and present as a pericardial mass.
We present images of a
CAA of the RCA with a fistula to the left ventricle (LV).
A 64-year-old female was evaluated for palpitations and found on
computed tomography (CT) scan to have a 6-cm right CAA (RCAA) with
a fistula to the posterior LV (Figures 1A and 1B). At the time of surgery,
cardiopulmonary bypass was instituted by aortic and bicaval cannula-
tion. The aorta was crossclamped and the heart arrested with
retrograde cold blood cardioplegia. The RCCA was opened, the fresh
clot removed, and the orifices of the branches were suture ligated
(Figures 2A and 2B). The RCCA fisutula was closed with a pericardial
patch and the ostium of the RCA was closed with a Dacron patch
(Figure 2C). An end-side anastomosis was performed to the posterio-
lateral branch using a segment of saphenous vein, followed by a side-
side anastomosis to the posterior descending artery, and a proximal
anastomosis to the ascending aorta (Figure 2D). The patient tolerated
the procedure well. A postoperative CT angiogram showed a patent
vein graft and closure of the RCCA orifice and fistula (Figure 1C). The
histology of the RCCA showed atherosclerotic changes and disruption
of the tunica media.
CONFLICTS OF INTEREST
The authors have declared that no conflicts of interest exists.
FIGURE 1 Three-dimensional computed tomography image shows enlargement of a giant RCAA. (A) A 6-cm right coronary artery aneurysm
is present. (B) The posterior image shows the posterior descending artery and posterolateral branch of RCA (arrows). The enlarged RCAA
terminated in the fistula to the posterior of the left ventricle (bold arrow). (C) The postoperative posterior image shows RCA side branches
bypassed by the SVG (arrows) and closure of the RCA orifice and fistula opening in the left ventricle (bold arrows). RCA, right coronary artery;
RCAA, right coronary artery aneurysms; SVG, saphenous vein graft
J Card Surg. 2018;33:95–96. wileyonlinelibrary.com/journal/jocs © 2018 Wiley Periodicals, Inc.