Surgical treatment of giant coronary artery aneurysm.
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.


CONCLUSIONS
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.
Li
Dianyuan
D
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. lidianyuan@founder.com
Wu
Qingyu
Q
Sun
Lizhong
L
Song
Yunhu
Y
Wang
Wei
W
Pan
Shiwei
S
Luo
Guohua
G
Liu
Yongmin
Y
Qi
Zhitao
Z
Tao
Tianfu
T
Sun
Jian-Zhong
JZ
Hu
Shengshou
S
D000328:Adult; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D003323:Coronary Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography