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J Thorac Cardiovasc Surg 2005;130:817-821
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Surgical treatment of giant coronary artery aneurysm

^a Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, The People's Republic of China
^b Department of Anesthesiology, Thomas Jefferson University, Philadelphia, Pa.

Received for publication February 16, 2005; revisions received March 26, 2005; accepted for publication April 5, 2005.

^_* Address for reprints: Dianyuan Li, MD, Department of Surgery, Fuwai Hospital, 167 Bei Li Shi RD, Xicheng District, Beijing 100037, The People's Republic of China. (Email: lidianyuan{at}founder.com).

OBJECTIVE: Giant coronary artery aneurysm is an extremely uncommon disease. Most previous reports have involved only single cases. This report describes 6 patients with giant coronary artery aneurysm, examines its causes, and aims to establish the optimal surgical strategies for this exceptional and rare pathology.

METHODS: From July 1996 to October 2004, a total of 30,268 patients underwent heart surgery at Fuwai Hospital in Beijing. Among these, 6 patients had giant coronary artery aneurysm diagnosed and underwent operation. Various surgical strategies were used for the operations of these 6 patients, such as coronary artery aneurysm resection, coronary artery reconstruction, and concomitant coronary bypass. Additional procedures, such as fistula closure, aortic valve replacement, aortoplasty, and embolectomy, were done at same time for the patients with complications of coronary fistula, aortic valve insufficiency, or thrombus. Patients were followed up from 8 to 87 months, with a mean of 48 months. Doppler echocardiography, ultrafast computed tomography, and 3-dimensional aerial image studies were performed during follow-up.

RESULTS: Five of these six cases were found combined with coronary artery fistula, and the cause for these giant coronary artery aneurysms was congenital. The remaining case was caused by atherosclerosis. After surgery, all patients recovered uneventfully, without in-hospital mortality. None died during the follow-up, nor did any have recurrence of the symptoms or giant coronary artery aneurysm.

CONCLUSION: Giant coronary artery aneurysm is a rare entity that is commonly caused by congenital malformation and combined with other cardiac anomalies. An optimal surgical operation should be based on the specific cardiac anomaly of the individual patient.

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