Total arterial coronary artery bypass grafting of multiple coronary aneurysms

Central MessageA rare case of multiple large coronary artery aneurysms was successfully managed with full arterial CABG, patch occlusion of the left main, and distal ligation of the left anterior descending artery.See Commentaries on pages 78 and 80.Giant coronary artery aneurysms (GCAAs) are rare, with a reported prevalence of 0.02% of aneurysms with a diameter >50 mm.1Li D. Wu Q. Sun L. Song Y. Wang W. Pan S. et al.Surgical treatment of giant coronary artery aneurysm.J Thorac Cardiovasc Surg. 2005; 130: 817-821Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar A threshold of 50 mm has been used to define GCAA in some studies,1Li D. Wu Q. Sun L. Song Y. Wang W. Pan S. et al.Surgical treatment of giant coronary artery aneurysm.J Thorac Cardiovasc Surg. 2005; 130: 817-821Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar,2Crawley P. Mahlow W.J. Huntsinger D.R. Afiniwala S. Wortham D.C. Giant coronary artery aneurysms.Tex Heart Inst J. 2014; 41: 603-608Crossref PubMed Scopus (66) Google Scholar while others suggest a diameter of ≥4 times the reference vessel size or ≥20 mm.3Kawsara A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar Most coronary artery aneurysms are asymptomatic and are found incidentally.3Kawsara A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar Complications of untreated coronary aneurysms include thromboembolism, spontaneous rupture, myocardial ischemia/infarction, compression, and fistula formation.3Kawsara A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar We report the surgical management of a patient who was found to have several large coronary aneurysms in all major coronary territories.Case DescriptionVideo 1Coronary angiogram cine of the left coronary system (right anterior oblique caudal view) depicting giant coronary aneurysms of the left anterior descending (LAD) artery and left circumflex artery (LCx). There is stagnant flow and retained angiographic dye in the giant coronary aneurysms. Note the radiographic shadows that indicate the true size of the aneurysms. The discrepancy between the radiographic shadow of the aneurysms and visualized flow within the aneurysms reflects existing thrombosis within the aneurysms. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00311-4/fulltext.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Video 2Coronary angiogram cine of the left coronary system (right anterior oblique cranial view) depicting two giant coronary aneurysms of the left anterior descending (LAD) artery and left circumflex artery (LCx). There is stagnant flow and retained angiographic dye in the giant coronary aneurysms. Note the radiographic shadows that indicate the true size of the aneurysms. The discrepancy between the radiographic shadow of the aneurysms and visualized flow within the aneurysms reflects existing thrombosis within the aneurysms. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00311-4/fulltext.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Video 3Coronary angiogram cine of the right coronary system (left anterior oblique view) depicting 2 coronary aneurysms in the right coronary artery (RCA). In addition to the 2 large sequential aneurysms in the RCA, there is a moderately stenotic lesion prior to the first RCA aneurysm and a highly stenotic lesion distal to the second RCA aneurysm. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00311-4/fulltext.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Video 4Preoperative computed tomography angiogram cine (axial plane) of multiple coronary aneurysms in a 74-year-old woman presenting with angina and syncope. There are giant coronary artery aneurysms on the left anterior descending (LAD) coronary artery and left circumflex (LCx) coronary artery. There are 2 large coronary artery aneurysms on the right coronary artery (RCA). There is also a coronary artery aneurysm seen on the first obtuse marginal artery. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00311-4/fulltext.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 1Preoperative imaging of giant coronary artery aneurysms in a 74-year-old woman presenting with angina and syncope. A, Chest X-ray showing the calcified outline of left anterior descending giant coronary artery aneurysm. B and C, 3-dimensional computed tomography scan reconstruction emphasizing left anterior descending (LAD) aneurysm and left circumflex (LCx) aneurysms in relation to each other. D, Coronary angiogram with anteroposterior view of left-sided giant coronary aneurysms. E, Coronary angiogram with right anterior oblique view of left-sided giant coronary aneurysms. F, Coronary angiogram with view of the right coronary artery (RCA) with multiple aneurysms and distal RCA stenosis. ∗LAD aneurysm; +, LCx aneurysm; ˆ, RCA aneurysm.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 2Computed tomography angiogram of preoperative (A, B, C) and 3-month postoperative (D, E, F) giant coronary aneurysms in a 74-year-old woman presenting with angina and syncope. A. Left anterior descending (LAD) giant coronary aneurysm with largest dimension of 5.5 × 4.8 cm. B, Left circumflex (LCx) giant coronary aneurysm with largest dimension of 3.9 × 2.7 cm. C, Distal right coronary artery (RCA) aneurysm with largest dimension of 1.8 × 1.2 cm. D, LAD thrombosed giant coronary aneurysm with largest dimension of 5.4 × 4.9 cm. E, LCx thrombosed giant coronary aneurysm with largest dimension of 3.8 × 2.7 cm. F, Distal RCA aneurysm with maximal dimension of 1.7 × 1.1 cm. ∗LAD aneurysm; +, LCx aneurysm; ˆ, RCA aneurysm.View Large Image Figure ViewerDownload Hi-res image Download (PPT)A multidisciplinary discussion was held, and several options were considered, including aneurysm coiling, covered stent placement, and coronary artery bypass grafting (CABG). Given the diffuse nature of the aneurysms, complex anatomy, and risk of rupture, a unanimous decision was made to pursue surgery, and the patient was consented. The Institutional Review Board at the University of Ottawa Heart Institute did not approve this study, as this approval is not required for case reports. The patient provided informed written consent for publication and dissemination of her anonymized clinical and radiographic information.Intraoperatively, owing to the size, location, and diffuse calcification of the LAD GCAA, an epicardial approach to open or occlude the LAD proximal to the aneurysm was deemed too risky. Alternatively, to occlude proximal flow, a small piece of pericardium was fashioned and sutured over the left main ostia from the inside via aortotomy (Figure 3). The LAD GCAA was occluded distally with a pledgeted Prolene suture. The LCx GCAA was difficult to address because of its location in the left atrial groove and was not ligated, to avoid inadvertent injury. All of the territories were bypassed with LITA-LAD, radial artery from the aorta to OM1 with sequential to OM2, and in The patient an postoperative of management of giant coronary aneurysms in a 74-year-old woman presenting with angina and syncope. A, patch fashioned from pericardium to patch over the left main coronary ostia a Prolene via an was to proximal of the left coronary system aneurysms. A pledgeted Prolene was also used to occlude the left anterior descending artery (LAD) aneurysm B, of aortotomy and LAD distal to the aneurysm. C, Coronary artery bypass grafting to all major coronary territories coronary aneurysms and The in right artery was to the distal right coronary artery (RCA). The in left artery was to the The radial artery was from the aorta to the first obtuse marginal artery and second obtuse marginal artery in sequential Large Image Figure ViewerDownload Hi-res image Download (PPT)Video computed tomography angiogram cine (axial plane) of multiple coronary aneurysms in a 74-year-old woman presenting with angina and syncope. There are giant coronary artery aneurysms on the left anterior descending (LAD) coronary artery and left circumflex (LCx) coronary artery. The giant coronary artery aneurysms are thrombosed with within the aneurysms. There are 2 large coronary artery aneurysms on the right coronary artery (RCA). There is also a coronary artery aneurysm seen on the first obtuse marginal artery. The coronary artery bypass The in right artery is to the distal RCA, and the in left artery is to the The left radial artery from the aorta to the first and second in sequential The of the coronary artery aneurysms are to the preoperative Video available at: https://www.jtcvs.org/article/S2666-2507(21)00311-4/fulltext.View Large Image Figure ViewerDownload Hi-res image Download report on a rare case of multiple coronary artery aneurysms of all major coronary including in the LAD and with surgical Most are seen in the RCA the left-sided P. Mahlow W.J. Huntsinger D.R. Afiniwala S. Wortham D.C. Giant coronary artery aneurysms.Tex Heart Inst J. 2014; 41: 603-608Crossref PubMed Scopus (66) Google A. Giant coronary aneurysms in Cardiovasc Thorac Surg. PubMed Scopus Google Scholar in in of a coronary aneurysm is A. Giant coronary aneurysms in Cardiovasc Thorac Surg. PubMed Scopus Google managed with or surgical A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar to surgical have been including CABG, with and patch D. Wu Q. Sun L. Song Y. Wang W. Pan S. et al.Surgical treatment of giant coronary artery aneurysm.J Thorac Cardiovasc Surg. 2005; 130: 817-821Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar,2Crawley P. Mahlow W.J. Huntsinger D.R. Afiniwala S. Wortham D.C. Giant coronary artery aneurysms.Tex Heart Inst J. 2014; 41: 603-608Crossref PubMed Scopus (66) Google S. S. M. A. et al.Surgical treatment of coronary artery Surg. PubMed Scopus Google Scholar used a approach with an and approach the the risk of the aneurysm to occlude there the risk of and the risk of is to and and arterial was for the of the preoperative and have grafting in coronary artery aneurysms, this is the first report in the arterial in the of multiple S. S. M. A. et al.Surgical treatment of coronary artery Surg. PubMed Scopus Google Scholar is for surgical approach to coronary aneurysms. in this are also of coronary artery aneurysms surgical left main aneurysms, multiple coronary aneurysms, compression, and A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar with on flow to the and of a and for the management of coronary aneurysms. A rare case of multiple large coronary artery aneurysms was successfully managed with full arterial CABG, patch occlusion of the left main, and distal ligation of the left anterior descending artery. A rare case of multiple large coronary artery aneurysms was successfully managed with full arterial CABG, patch occlusion of the left main, and distal ligation of the left anterior descending artery. Commentaries on pages 78 and Commentaries on pages 78 and Giant coronary artery aneurysms (GCAAs) are rare, with a reported prevalence of 0.02% of aneurysms with a diameter >50 mm.1Li D. Wu Q. Sun L. Song Y. Wang W. Pan S. et al.Surgical treatment of giant coronary artery aneurysm.J Thorac Cardiovasc Surg. 2005; 130: 817-821Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar A threshold of 50 mm has been used to define GCAA in some studies,1Li D. Wu Q. Sun L. Song Y. Wang W. Pan S. et al.Surgical treatment of giant coronary artery aneurysm.J Thorac Cardiovasc Surg. 2005; 130: 817-821Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar,2Crawley P. Mahlow W.J. Huntsinger D.R. Afiniwala S. Wortham D.C. Giant coronary artery aneurysms.Tex Heart Inst J. 2014; 41: 603-608Crossref PubMed Scopus (66) Google Scholar while others suggest a diameter of ≥4 times the reference vessel size or ≥20 mm.3Kawsara A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar Most coronary artery aneurysms are asymptomatic and are found incidentally.3Kawsara A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar Complications of untreated coronary aneurysms include thromboembolism, spontaneous rupture, myocardial ischemia/infarction, compression, and fistula formation.3Kawsara A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar We report the surgical management of a patient who was found to have several large coronary aneurysms in all major coronary DescriptionVideo 2Coronary angiogram cine of the left coronary system (right anterior oblique cranial view) depicting two giant coronary aneurysms of the left anterior descending (LAD) artery and left circumflex artery (LCx). There is stagnant flow and retained angiographic dye in the giant coronary aneurysms. Note the radiographic shadows that indicate the true size of the aneurysms. The discrepancy between the radiographic shadow of the aneurysms and visualized flow within the aneurysms reflects existing thrombosis within the aneurysms. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00311-4/fulltext.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Video 3Coronary angiogram cine of the right coronary system (left anterior oblique view) depicting 2 coronary aneurysms in the right coronary artery (RCA). In addition to the 2 large sequential aneurysms in the RCA, there is a moderately stenotic lesion prior to the first RCA aneurysm and a highly stenotic lesion distal to the second RCA aneurysm. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00311-4/fulltext.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Video 4Preoperative computed tomography angiogram cine (axial plane) of multiple coronary aneurysms in a 74-year-old woman presenting with angina and syncope. There are giant coronary artery aneurysms on the left anterior descending (LAD) coronary artery and left circumflex (LCx) coronary artery. There are 2 large coronary artery aneurysms on the right coronary artery (RCA). There is also a coronary artery aneurysm seen on the first obtuse marginal artery. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00311-4/fulltext.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 1Preoperative imaging of giant coronary artery aneurysms in a 74-year-old woman presenting with angina and syncope. A, Chest X-ray showing the calcified outline of left anterior descending giant coronary artery aneurysm. B and C, 3-dimensional computed tomography scan reconstruction emphasizing left anterior descending (LAD) aneurysm and left circumflex (LCx) aneurysms in relation to each other. D, Coronary angiogram with anteroposterior view of left-sided giant coronary aneurysms. E, Coronary angiogram with right anterior oblique view of left-sided giant coronary aneurysms. F, Coronary angiogram with view of the right coronary artery (RCA) with multiple aneurysms and distal RCA stenosis. ∗LAD aneurysm; +, LCx aneurysm; ˆ, RCA aneurysm.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 2Computed tomography angiogram of preoperative (A, B, C) and 3-month postoperative (D, E, F) giant coronary aneurysms in a 74-year-old woman presenting with angina and syncope. A. Left anterior descending (LAD) giant coronary aneurysm with largest dimension of 5.5 × 4.8 cm. B, Left circumflex (LCx) giant coronary aneurysm with largest dimension of 3.9 × 2.7 cm. C, Distal right coronary artery (RCA) aneurysm with largest dimension of 1.8 × 1.2 cm. D, LAD thrombosed giant coronary aneurysm with largest dimension of 5.4 × 4.9 cm. E, LCx thrombosed giant coronary aneurysm with largest dimension of 3.8 × 2.7 cm. F, Distal RCA aneurysm with maximal dimension of 1.7 × 1.1 cm. ∗LAD aneurysm; +, LCx aneurysm; ˆ, RCA aneurysm.View Large Image Figure ViewerDownload Hi-res image Download (PPT)A multidisciplinary discussion was held, and several options were considered, including aneurysm coiling, covered stent placement, and coronary artery bypass grafting (CABG). Given the diffuse nature of the aneurysms, complex anatomy, and risk of rupture, a unanimous decision was made to pursue surgery, and the patient was consented. The Institutional Review Board at the University of Ottawa Heart Institute did not approve this study, as this approval is not required for case reports. The patient provided informed written consent for publication and dissemination of her anonymized clinical and radiographic information.Intraoperatively, owing to the size, location, and diffuse calcification of the LAD GCAA, an epicardial approach to open or occlude the LAD proximal to the aneurysm was deemed too risky. Alternatively, to occlude proximal flow, a small piece of pericardium was fashioned and sutured over the left main ostia from the inside via aortotomy (Figure 3). The LAD GCAA was occluded distally with a pledgeted Prolene suture. The LCx GCAA was difficult to address because of its location in the left atrial groove and was not ligated, to avoid inadvertent injury. All of the territories were bypassed with LITA-LAD, radial artery from the aorta to OM1 with sequential to OM2, and in The patient an postoperative of management of giant coronary aneurysms in a 74-year-old woman presenting with angina and syncope. A, patch fashioned from pericardium to patch over the left main coronary ostia a Prolene via an was to proximal of the left coronary system aneurysms. A pledgeted Prolene was also used to occlude the left anterior descending artery (LAD) aneurysm B, of aortotomy and LAD distal to the aneurysm. C, Coronary artery bypass grafting to all major coronary territories coronary aneurysms and The in right artery was to the distal right coronary artery (RCA). The in left artery was to the The radial artery was from the aorta to the first obtuse marginal artery and second obtuse marginal artery in sequential Large Image Figure ViewerDownload Hi-res image Download (PPT)Video computed tomography angiogram cine (axial plane) of multiple coronary aneurysms in a 74-year-old woman presenting with angina and syncope. There are giant coronary artery aneurysms on the left anterior descending (LAD) coronary artery and left circumflex (LCx) coronary artery. The giant coronary artery aneurysms are thrombosed with within the aneurysms. There are 2 large coronary artery aneurysms on the right coronary artery (RCA). There is also a coronary artery aneurysm seen on the first obtuse marginal artery. The coronary artery bypass The in right artery is to the distal RCA, and the in left artery is to the The left radial artery from the aorta to the first and second in sequential The of the coronary artery aneurysms are to the preoperative Video available at: https://www.jtcvs.org/article/S2666-2507(21)00311-4/fulltext.View Large Image Figure ViewerDownload Hi-res image Download A multidisciplinary discussion was held, and several options were considered, including aneurysm coiling, covered stent placement, and coronary artery bypass grafting (CABG). Given the diffuse nature of the aneurysms, complex anatomy, and risk of rupture, a unanimous decision was made to pursue surgery, and the patient was consented. The Institutional Review Board at the University of Ottawa Heart Institute did not approve this study, as this approval is not required for case reports. The patient provided informed written consent for publication and dissemination of her anonymized clinical and radiographic owing to the size, location, and diffuse calcification of the LAD GCAA, an epicardial approach to open or occlude the LAD proximal to the aneurysm was deemed too risky. Alternatively, to occlude proximal flow, a small piece of pericardium was fashioned and sutured over the left main ostia from the inside via aortotomy (Figure 3). The LAD GCAA was occluded distally with a pledgeted Prolene suture. The LCx GCAA was difficult to address because of its location in the left atrial groove and was not ligated, to avoid inadvertent injury. All of the territories were bypassed with LITA-LAD, radial artery from the aorta to OM1 with sequential to OM2, and in The patient an postoperative report on a rare case of multiple coronary artery aneurysms of all major coronary including in the LAD and with surgical Most are seen in the RCA the left-sided P. Mahlow W.J. Huntsinger D.R. Afiniwala S. Wortham D.C. Giant coronary artery aneurysms.Tex Heart Inst J. 2014; 41: 603-608Crossref PubMed Scopus (66) Google A. Giant coronary aneurysms in Cardiovasc Thorac Surg. PubMed Scopus Google Scholar in in of a coronary aneurysm is A. Giant coronary aneurysms in Cardiovasc Thorac Surg. PubMed Scopus Google managed with or surgical A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar to surgical have been including CABG, with and patch D. Wu Q. Sun L. Song Y. Wang W. Pan S. et al.Surgical treatment of giant coronary artery aneurysm.J Thorac Cardiovasc Surg. 2005; 130: 817-821Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar,2Crawley P. Mahlow W.J. Huntsinger D.R. Afiniwala S. Wortham D.C. Giant coronary artery aneurysms.Tex Heart Inst J. 2014; 41: 603-608Crossref PubMed Scopus (66) Google S. S. M. A. et al.Surgical treatment of coronary artery Surg. PubMed Scopus Google Scholar used a approach with an and approach the the risk of the aneurysm to occlude there the risk of and the risk of is to and and arterial was for the of the preoperative and have grafting in coronary artery aneurysms, this is the first report in the arterial in the of multiple S. S. M. A. et al.Surgical treatment of coronary artery Surg. PubMed Scopus Google Scholar is for surgical approach to coronary aneurysms. in this are also of coronary artery aneurysms surgical left main aneurysms, multiple coronary aneurysms, compression, and A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar with on flow to the and of a and for the management of coronary aneurysms. We report on a rare case of multiple coronary artery aneurysms of all major coronary including in the LAD and with surgical Most are seen in the RCA the left-sided P. Mahlow W.J. Huntsinger D.R. Afiniwala S. Wortham D.C. Giant coronary artery aneurysms.Tex Heart Inst J. 2014; 41: 603-608Crossref PubMed Scopus (66) Google A. Giant coronary aneurysms in Cardiovasc Thorac Surg. PubMed Scopus Google Scholar in in of a coronary aneurysm is A. Giant coronary aneurysms in Cardiovasc Thorac Surg. PubMed Scopus Google Scholar managed with or surgical A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar to surgical have been including CABG, with and patch D. Wu Q. Sun L. Song Y. Wang W. Pan S. et al.Surgical treatment of giant coronary artery aneurysm.J Thorac Cardiovasc Surg. 2005; 130: 817-821Abstract Full Text Full Text PDF PubMed Scopus (139) Google Scholar,2Crawley P. Mahlow W.J. Huntsinger D.R. Afiniwala S. Wortham D.C. Giant coronary artery aneurysms.Tex Heart Inst J. 2014; 41: 603-608Crossref PubMed Scopus (66) Google S. S. M. A. et al.Surgical treatment of coronary artery Surg. PubMed Scopus Google Scholar used a approach with an and approach the the risk of the aneurysm to occlude there the risk of and the risk of is to and and arterial was for the of the preoperative and have grafting in coronary artery aneurysms, this is the first report in the arterial in the of multiple S. S. M. A. et al.Surgical treatment of coronary artery Surg. PubMed Scopus Google Scholar is for surgical approach to coronary aneurysms. in this are also of coronary artery aneurysms surgical left main aneurysms, multiple coronary aneurysms, compression, and A. Núñez Gil I.J. Alqahtani F. Moreland J. Rihal C.S. Alkhouli M. Management of coronary artery aneurysms.JACC Cardiovasc Interv. 2018; 11: 1211-1223Crossref PubMed Scopus (120) Google Scholar with on flow to the and of a and for the management of coronary aneurysms. Download with Video 1Coronary angiogram cine of the left coronary system (right anterior oblique caudal view) depicting giant coronary aneurysms of the left anterior descending (LAD) artery and left circumflex artery (LCx). There is stagnant flow and retained angiographic dye in the giant coronary aneurysms. Note the radiographic shadows that indicate the true size of the aneurysms. The discrepancy between the radiographic shadow of the aneurysms and visualized flow within the aneurysms reflects existing thrombosis within the aneurysms. Video available at: Download with Video 2Coronary angiogram cine of the left coronary system (right anterior oblique cranial view) depicting two giant coronary aneurysms of the left anterior descending (LAD) artery and left circumflex artery (LCx). There is stagnant flow and retained angiographic dye in the giant coronary aneurysms. Note the radiographic shadows that indicate the true size of the aneurysms. The discrepancy between the radiographic shadow of the aneurysms and visualized flow within the aneurysms reflects existing thrombosis within the aneurysms. Video available at: Download with Video 3Coronary angiogram cine of the right coronary system (left anterior oblique view) depicting 2 coronary aneurysms in the right coronary artery (RCA). In addition to the 2 large sequential aneurysms in the RCA, there is a moderately stenotic lesion prior to the first RCA aneurysm and a highly stenotic lesion distal to the second RCA aneurysm. Video available at: Download with Video 4Preoperative computed tomography angiogram cine (axial plane) of multiple coronary aneurysms in a 74-year-old woman presenting with angina and syncope. There are giant coronary artery aneurysms on the left anterior descending (LAD) coronary artery and left circumflex (LCx) coronary artery. There are 2 large coronary artery aneurysms on the right coronary artery (RCA). There is also a coronary artery aneurysm seen on the first obtuse marginal artery. Video available at: Download with Video computed tomography angiogram cine (axial plane) of multiple coronary aneurysms in a 74-year-old woman presenting with angina and syncope. There are giant coronary artery aneurysms on the left anterior descending (LAD) coronary artery and left circumflex (LCx) coronary artery. The giant coronary artery aneurysms are thrombosed with within the aneurysms. There are 2 large coronary artery aneurysms on the right coronary artery (RCA). There is also a coronary artery aneurysm seen on the first obtuse marginal artery. The coronary artery bypass The in right artery is to the distal RCA, and the in left artery is to the The left radial artery from the aorta to the first and second in sequential The of the coronary artery aneurysms are to the preoperative Video available at: Download with Video 1Coronary angiogram cine of the left coronary system (right anterior oblique caudal view) depicting giant coronary aneurysms of the left anterior descending (LAD) artery and left circumflex artery (LCx). There is stagnant flow and retained angiographic dye in the giant coronary aneurysms. Note the radiographic shadows that indicate the true size of the aneurysms. The discrepancy between the radiographic shadow of the aneurysms and visualized flow within the aneurysms reflects existing thrombosis within the aneurysms. Video available at: Download with Video 2Coronary angiogram cine of the left coronary system (right anterior oblique cranial view) depicting two giant coronary aneurysms of the left anterior descending (LAD) artery and left circumflex artery (LCx). There is stagnant flow and retained angiographic dye in the giant coronary aneurysms. Note the radiographic shadows that indicate the true size of the aneurysms. The discrepancy between the radiographic shadow of the aneurysms and visualized flow within the aneurysms reflects existing thrombosis within the aneurysms. Video available at: Download with Video 3Coronary angiogram cine of the right coronary system (left anterior oblique view) depicting 2 coronary aneurysms in the right coronary artery (RCA). In addition to the 2 large sequential aneurysms in the RCA, there is a moderately stenotic lesion prior to the first RCA aneurysm and a highly stenotic lesion distal to the second RCA aneurysm. Video available at: Download with Video 4Preoperative computed tomography angiogram cine (axial plane) of multiple coronary aneurysms in a 74-year-old woman presenting with angina and syncope. There are giant coronary artery aneurysms on the left anterior descending (LAD) coronary artery and left circumflex (LCx) coronary artery. There are 2 large coronary artery aneurysms on the right coronary artery (RCA). There is also a coronary artery aneurysm seen on the first obtuse marginal artery. Video available at: Download with Video computed tomography angiogram cine (axial plane) of multiple coronary aneurysms in a 74-year-old woman presenting with angina and syncope. There are giant coronary artery aneurysms on the left anterior descending (LAD) coronary artery and left circumflex (LCx) coronary artery. The giant coronary artery aneurysms are thrombosed with within the aneurysms. There are 2 large coronary artery aneurysms on the right coronary artery (RCA). There is also a coronary artery aneurysm seen on the first obtuse marginal artery. The coronary artery bypass The in right artery is to the distal RCA, and the in left artery is to the The left radial artery from the aorta to the first and second in sequential The of the coronary artery aneurysms are to the preoperative Video available at: coronary aneurysms surgical the available surgical and the are with to coronary this case report an to this coronary aneurysms in a stenotic coronary for coronary artery bypass grafting a of aneurysm aneurysms The surgical are aneurysm and distal PDF with the aneurysms are rare and a management to and of on management the of and an clinical Giant coronary artery aneurysms this the of rupture, compression, and fistula to as myocardial and or as PDF

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