title: Staged hybrid treatment for contained rupture of a large right coronary artery aneurysm.
abstract: We describe a staged approach to the management of a rare acute condition--contained rupture of a large right coronary artery aneurysm. A covered stent was deployed percutaneously to isolate the aneurysm at presentation followed by planned coronary bypass grafting. Treatment interval was complicated by new-onset pulmonary tuberculosis and subacute thrombosis of the covered stent leading to nonfatal inferior myocardial infarction. Coronary surgery was performed after complete antitubercular treatment and resolution of the acute pericarditis/thrombosis as a consequence of the contained rupture. The advantages of this staged approach included the following: (a) The covered stent prevented both acute myocardial infarction and progressive pseudoaneurysm expansion in the acute phase. (b) Deferred surgery was rendered technically less hazardous while avoiding the undesirable option of having to exclude an extremely calcified dominant right coronary artery. The patient made an excellent postoperative recovery with complete resolution of her symptoms at 6 weeks' follow-up.
authors.affiliation: From the Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Victoria Hospital, Blackpool, UK.
authors.forename: Espeed
authors.initials: E
authors.lastname: Khoshbin
authors.forename: Franco
authors.initials: F
authors.lastname: Sogliani
authors.forename: Augustine
authors.initials: A
authors.lastname: Tang
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery*; D020099:Coated Materials, Biocompatible; D003323:Coronary Aneurysm / Q000175:diagnosis / Q000601:surgery*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000601:surgery*; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005500:Follow-Up Studies; D006801:Humans; D011474:Prosthesis Design; D015607:Stents; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D020099:Coated Materials, Biocompatible