Pfister Raymond, Sadeghi Yalda, Orrit Javier, Prêtre René
Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland.
J Cardiothorac Surg. 2019 Mar 8;14(1):52. doi: 10.1186/s13019-019-0872-4.
Coronary artery aneurysms (CAA) are defined as localized coronary artery dilations more than 1.5 times the diameter of the adjacent segments [1]. Giant coronary aneurysms (GCAA) are unusual and aneurysms on the left side are even rarer. Mechanisms are unclear, but seem predominated by atherosclerosis. Until now, management of giant coronary aneurysm is still unclear.
A 62-year-old man, presented a 4-month history of progressive chest pain aggravated by physical CAAs: 3 on the right coronary artery (RCA), including a giant one, and one on the intermediate branch. Intraoperatively, we found two proximal RCA CAAs of 2 cm each, a 6 cm distal RCA CAA partially thrombosed, and a 3 cm CAA on the intermediate branch. The two largest CAAs were resected and two saphenous graft bypasses were performed.
Treatment options include medical treatment (antiaggregation, anticoagulation), percutaneous coronary angioplasty and surgery. Results of observational or conservative management in the few cases of GCAA described in literature, appear to have poor results. Surgery is a good option with low operative risk, especially in giant coronary aneurysms.
冠状动脉瘤（CAA）定义为局限性冠状动脉扩张，其直径超过相邻节段直径的1.5倍[1]。巨大冠状动脉瘤（GCAA）并不常见，左侧的动脉瘤更为罕见。其发病机制尚不清楚，但似乎以动脉粥样硬化为主。迄今为止，巨大冠状动脉瘤的治疗方法仍不明确。
一名62岁男性，有4个月进行性胸痛病史，体力活动可加重。冠状动脉造影显示右侧冠状动脉（RCA）有3个动脉瘤，包括1个巨大动脉瘤，中间支有1个动脉瘤。术中，我们发现右冠状动脉近端有2个各为2厘米的动脉瘤，右冠状动脉远端有1个6厘米的动脉瘤，部分血栓形成，中间支有1个3厘米的动脉瘤。切除了两个最大的动脉瘤，并进行了两条大隐静脉移植搭桥术。
治疗选择包括药物治疗（抗聚集、抗凝）、经皮冠状动脉成形术和手术。文献中描述的少数巨大冠状动脉瘤病例的观察或保守治疗结果似乎较差。手术是一种不错的选择，手术风险低，尤其是对于巨大冠状动脉瘤。
