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Successful surgical treatment of a giant coronary aneurysm communicating with the right atrium

Rognoni, Andrea; Ferrero, Valeria; Teodori, Giovanni; Ribichini, Flavio

Journal of Cardiovascular Medicine: December 2007 - Volume 8 - Issue 12 - p 1061–1064
doi: 10.2459/JCM.0b013e32805f0d09
Case reports
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Aneurysms of the coronary arteries are rare events. In most cases, such abnormalities are clinically silent and, when they cause symptoms, there are dyspnea and/or angina. Our report describes a case presenting with dyspnea; the admission electrocardiogram demonstrated largely spread ischemia in the lower-lateral leads and myocardial necrosis in the inferior wall. Selective coronary angiography disclosed severe three-vessel disease; aortic angiography revealed a large vascular neoformation, partly thrombosed, with multilobes and a wide communication with the ascending aorta; the oxygen run showed a slight, non-significant ‘jump’ at the level of the right atrium, confirming a possible left-to-right shunt. On open chest surgery, these alterations were confirmed. The principal aneurysm (6–7 cm) originating in right auricle gave rise to a localized pseudoaneurysm above the superior vena cava; the other three aneurysmal structures were situated along the course of the right coronary artery. After 2 years of clinical and echocardiographic control, the patient is symptom-free under conventional medical treatment.

aDivisione Clinicizzata di Cardiologia, Azienda Ospedaliera ‘Maggiore della Carità’, Novara, Italy

bCardiologia Universitaria, Ospedale Borgo Trento, Verona, Italy

cDivisione di Cardiochirurgia, Azienda Ospedaliera ‘Maggiore della Carità’, Novara, Italy

Received 12 October, 2006

Revised 14 December, 2006

Accepted 21 December, 2006

Correspondence and requests for reprints to Andrea Rognoni, Divisione Clinicizzata di Cardiologia, Università degli Studi del Piemonte Orientale, Azienda Ospedaliera ‘Maggiore della Carità’, Corso Mazzini 18, 28110 Novara, Italy Tel: +39 0321 3733294; fax: +39 0321 3733407; e-mail: arognoni@hotmail.com

© 2007 Italian Federation of Cardiology. All rights reserved.