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Table of Contents
CASE REPORT  
Year : 2020  |  Volume : 23  |  Issue : 2  |  Page : 230-231
Congenital giant right coronary artery


1 Department of Cardiac Anesthesia, Artemis Hospital, Gurugram, Haryana, India
2 Department of Pediatric Cardiac Surgery, Artemis Hospital, Gurugram, Haryana, India
3 Department of Pediatric Cardiology, Artemis Hospital, Gurugram, Haryana, India

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Date of Submission10-Sep-2018
Date of Decision24-Nov-2018
Date of Acceptance07-Jan-2019
Date of Web Publication07-Apr-2020
 

   Abstract 


Giant coronary artery aneurysms are exceptionally uncommon with an incidence of 0.02%. The natural history and prognosis of giant coronary artery aneurysm are still not well known.

Keywords: Aneurysm, congenital, giant coronary artery

How to cite this article:
Raut MS, Hanjoora VM, Srivastava AR, Khangarot SS, Jyoti A, Mahajan V, Rawal N. Congenital giant right coronary artery. Ann Card Anaesth 2020;23:230-1

How to cite this URL:
Raut MS, Hanjoora VM, Srivastava AR, Khangarot SS, Jyoti A, Mahajan V, Rawal N. Congenital giant right coronary artery. Ann Card Anaesth [serial online] 2020 [cited 2020 Jun 6];23:230-1. Available from: http://www.annals.in/text.asp?2020/23/2/230/282065




Giant coronary artery aneurysms are exceptionally uncommon with an incidence of 0.02%.[1],[2],[3] Commonly observed cause of coronary artery aneurysm are atherosclerotic coronary artery disease, followed by Takayasu's arteritis, Kawasaki's disease, iatrogenic complications such as stent implantation, and infectious endocarditis.[4],[5] Coronary artery aneurysm forms fistulous connection generally with right heart chamber structures. Most cases of coronary artery aneurysm (congenital or acquired) are reported in adult patients usually during coronary angiography. It is very rare to find such giant coronary artery in pediatric patient during cardiac surgery.

A 1-year-old female patient, diagnosed as tetralogy of Fallot, was referred to our center for modified Blalock–Taussig shunt. Catheterisation study report from other center did not reveal any significant abnormality. Intraoperative transesophageal echocardiographic aortic valve short axis view showed hugely dilated right coronary artery (RCA) [Figure 1] with color flow [Figure 2] Transesophageal echocardiographic long axis view revealed subaortic ventricular septal defect with large RCA [Figure 3]. After midline sternotomy, operative findings confirmed unusually large RCA with fistulous connection to main pulmonary artery [Figure 4].
Figure 1: Transesophageal echocardiographic aortic valve short axis view showed huge dilated right coronary artery

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Figure 2: Transesophageal echocardiographic aortic valve short axis view showed huge dilated right coronary artery with color flow

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Figure 3: Transesophageal echocardiographic long axis view revealed subaortic ventricular septal defect with large RCA

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Figure 4: Surgical picture showing large RCA

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Giant coronary artery aneurysm is defined when its diameter exceeds 2 cm. In the present case, diameter of RCA was 5.2 cm. The natural history and prognosis of giant coronary artery aneurysm are still not well known.

Although most of the patients with coronary artery aneurysm are asymptomatic but they may present with complications such as thrombosis, rupture, tamponade, or myocardial ischemia.[6] Due to rarity of the lesion, no evidence-based guidelines are recommended yet. Even though asymptomatic patients with small aneurysms can be managed conservatively, anecdotal case reports of adult patients suggest surgical or interventional therapy for giant and symptomatic aneurysms. Aneurysmal resection along with fistula closure and coronary artery bypass grafting is the preferred surgery.[7]

In cyanotic heart disease, extramural coronary arteries may initially dilate due to increased endothelial nitric oxide and prostaglandins in response to raised shear stress of the viscous erythrocytotic perfusate.[8] Aneurysmal dilatation can also possibly be explained by mural attenuation owing to coexisting medial abnormalities of elastic fibers, smooth muscle, ground substance, and collagen prevalent in a variety of congenital heart diseases.[9] Previously one case with aneurysmally dilated coronary artery with fistula in an adult patient of tetralogy of Fallot was reported. The patient underwent total correction but without any intervention on coronary artery and fistula.[10] However, the present case involves a much younger child with larger coronary artery aneurysm. Considering the infantile age of the present case, only modified Blalock–Taussig shunt was performed and postoperatively antiplatelet therapy was started.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Barr J, Acharya MN, Kourliouros A, Raja SG. Technical considerations of giant right coronary artery aneurysm exclusion, Case Rep Surg 2016;2016:3795640.  Back to cited text no. 1
    
2.
Nichols L, Lagana S, Parwani A, Coronary artery aneurysm: A review and hypothesis regarding etiology, Arch Pathol Lab Med 2008;132:823-8.  Back to cited text no. 2
    
3.
Fernandes ED, Kadivar H, Hallman GL, Reul GJ, Ott DA, Cooley DA. Congenital malformations of the coronary arteries: The Texas Heart Institute experience. Ann Thorac Surg 1992;54:732-40.  Back to cited text no. 3
    
4.
Kanamitsu H, Yoshitaka H, Kuinose M, Tsushima Y. Giant right coronary artery aneurysm complicated by acute myocardial infarction, Gen Thorac Cardiovasc Surg 2010;58:186-9.  Back to cited text no. 4
    
5.
Tsuda E, Kamiya T, Ono Y, Kimura K, Echigo S. Dilated coronary arterial lesions in the late Gurgaon which stateperiod after Kawasaki disease. Heart 2005;91:177-82.  Back to cited text no. 5
    
6.
Jha NK, Ouda HZ, Khan JA, Eising GP, Augustin N. Giant right coronary artery aneurysm- case report and literature review. J Cardiothorac Surg 2009;4:18.  Back to cited text no. 6
    
7.
Dolapoglu A, Ott DA. Giant right coronary artery aneurysm associated with a fistula draining into the superior vena cava. Tex Heart Inst J 2016;43:360-2.  Back to cited text no. 7
    
8.
Perloff JK. Cyanotic congenital heart disease the coronary arterial circulation. Curr Cardiol Rev 2012;8:1-5.  Back to cited text no. 8
    
9.
Niwa K, Perloff JK, Bhuta SM, Laks H, Drinkwater DC, Child JS, et al. Structural abnormalities of great arterial walls in congenital heart disease: Light and electron microscopic analyses. Circulation 2001;103:393-400.  Back to cited text no. 9
    
10.
Fedakar A, Şaşmazel A, Bugra O, Boyacıoǧlu K, Baysal A, İnci A, et al. Coronary artery aneurysm and coronary fistula in tetrology of fallot: A case presentation of a young adult undergoing total correction. Kosuyolu Heart J 2010;13:23-5.  Back to cited text no. 10
    

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Correspondence Address:
Monish S Raut
Department of Cardiac Anesthesia, Artemis Hospital, Gurugram, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_181_18

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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