Giant Coronary Artery Aneurysm Combined Coronary Right Ventricle Fistula

HomeCirculation: Cardiovascular ImagingVol. 13, No. 4Giant Coronary Artery Aneurysm Combined Coronary Right Ventricle Fistula Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessCase ReportPDF/EPUBGiant Coronary Artery Aneurysm Combined Coronary Right Ventricle Fistula Song Yang, MD, Mengya Liang, MD, Guangxian Chen, MD, Mei Yang, BS and Zhong-kai Wu, MD, PhD Song YangSong Yang Cardiothoracic Surgical ICU (S.Y.), First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. , Mengya LiangMengya Liang The Second Department of Cardiac Surgery (M.L., G.C., Z.-k.W.), First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. , Guangxian ChenGuangxian Chen The Second Department of Cardiac Surgery (M.L., G.C., Z.-k.W.), First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. , Mei YangMei Yang Nursing center, Yuexiu Meihua Community Health Service Center, Guangzhou, China (M.Y.). and Zhong-kai WuZhong-kai Wu Zhong-kai Wu, MD, PhD, The Second Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, 58 2nd Zhongshan Rd, Guangzhou 510080, China. Email E-mail Address: [email protected] The Second Department of Cardiac Surgery (M.L., G.C., Z.-k.W.), First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Originally published25 Mar 2020https://doi.org/10.1161/CIRCIMAGING.119.010166Circulation: Cardiovascular Imaging. 2020;13:e010166A 28-year-old woman with no history of heart disease presented with symptoms of chest congestion and palpitations after activities for 5 years. On physical examination, she had a continuous murmur at the left sternal area cross with the third and fourth intercostal space. The electrocardiography was normal. Chest radiography in the posteroanterior view was normal. The patient underwent computed tomography, which revealed a giant coronary aneurysm (37 mm) that was on the apex and formed a fistula to the right ventricle (Figure [A through D]; Movie I in the Data Supplement). Myocardial contrast techocardiography showed a giant coronary aneurysm at the distal part of the left anterior descending and there was continuous flow from the region of the coronary aneurysm to right ventricle suggestive of a coronary fistula (Figure [E and F]; Movie II in the Data Supplement). At the same time, coronary angiography was performed. The left anterior descending artery enlarged nearly all the way. The left anterior descending coronary artery opened into a large spherical cavity—an aneurysm that measured 37 by 29 mm—that filled with contrast material in a swirling fashion and the fistula to right ventricle, and the magnetic resonance imaging angiography also confirmed the coronary aneurysm and fistula (Figure [G through J]; Movie III in the Data Supplement). The patient underwent the selective operation and was discharged a few days after the operation. There was no thrombus found in the aneurysm during the operation. We have performed the operation according to discussion results from the multiple disciplinary team. The preoperative image simunation was near to actual. The follow-up techocardiography and computed tomography showed excellent effective of operation (Figure [K through N]; Movie IV in the Data Supplement).There were a few problems to be solved before the operation. The first one was the location of the coronary aneurysm. For example, did the aneurysm locate external to the right ventricular wall or in the right ventricular wall? If the aneurysm located external to the right ventricular wall, we might just close the inside tunnel. If the aneurysm located in the right ventricular wall, we could perform the ventricular wall reconstruction. The computed tomography and 3-dimensional reconstruction could help us to distinguish. The second one was the hemodynamics of the coronary aneurysm and the fistula. The myocardial contras techocardiography and magnetic resonance imaging could help us to know the blood flow direction. The third one was that was there any thrombus inside the aneurysm? If it is, we should prevent from thrombus obstruction in distal coronary artery. Both computed tomography and magnetic resonance imaging could be effective.Download figureDownload PowerPointFigure. Multiple examination images.A–D, Coronary computed tomography (CT) angiography and 3-dimensional reconstruction of coronary artery showed the giant coronary aneurysm (green arrow). E and F, Myocardial contrast echocardiography. E, Coronary artery aneurysm (purple arrow) in the beginning of contrast agent injection from vein. F, Coronary artery aneurysm (purple arrow) a few heart beats later. G–J, Magnetic resonance imaging angiography showed the coronary artery aneurysm (yellow arrow) from different views. K, The follow-up echocardiography, the cavity of coronary aneurysm was filled with hyperechoic materials (orange arrow) and the fistula disappeared. L–N, The follow-up CT and 3-dimensional reconstruction showed that coronary aneurysm cavity reduced (white arrow) and the fistula disappeared. The left anterior descending coronary artery diminished.Sources of FundingThis study was supported by the National Key R&D Program of China (2017YFC1105000) and the National Natural Science Foundation of China (81370215, 81570039, 81770319, and 81900294).DisclosuresNone.FootnotesThe Data Supplement is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.119.010166.Zhong-kai Wu, MD, PhD, The Second Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, 58 2nd Zhongshan Rd, Guangzhou 510080, China. Email [email protected]sysu.edu.cn Previous Back to top Next FiguresReferencesRelatedDetails April 2020Vol 13, Issue 4 Advertisement Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.119.010166PMID: 32208735 Originally publishedMarch 25, 2020 Keywordscoronary aneurysmheart ventricleshumansfistulafollow-up studiesPDF download Advertisement SubjectsCardiovascular SurgeryCoronary Artery DiseaseImagingMagnetic Resonance Imaging (MRI)Quality and Outcomes