Halyckyj-Smith Joshua, Rose David
University of Manchester, Royal Preston Hospital, Lancashire Teaching Hospitals Trust, Sharoe Green Ln, Fulwood, Preston PR2 9HT, UK.
Lancashire Cardiac Centre, Blackpool Victoria Hospital, Whinney Heys Rd, Blackpool FY3 8NP, UK.
Eur Heart J Case Rep. 2024 Sep 3;8(10):ytae357. doi: 10.1093/ehjcr/ytae357. eCollection 2024 Oct.
Coronary artery aneurysms (CAAs) are uncommon and can cause complications such as thrombosis, vessel rupture, or distal embolization. Rarely, CAAs are classified as 'giant', although the defining diameter is debated. The predominant cause of CAAs is atherosclerotic disease. Independently, CAAs constitute an estimated 5-year survival of 71%.
We report the case of a 56-year-old female who presented 20 years ago with a chest infection when a murmur was auscultated on examination. Subsequently, a coronary angiogram was performed, demonstrating an extensive aneurysm of the right coronary artery (RCA). The aneurysmal segment of the RCA was resected, and a length of saphenous vein was utilized in its reconstruction. Twenty years later, the patient re-presented with dyspnoea, indicating repeat investigations; coronary angiography demonstrated a vein graft 20 years post-reconstruction that is almost indistinguishable from a native RCA.
The optimal management strategy for CAAs is debatable, and there are no clear guidelines. However, surgical management is generally preferred in cases of GCAAs, which was also the case for this patient. This reconstruction procedure, involving resection of the aneurysmal segment of the RCA and reconstruction with a saphenous vein graft, proved to be a durable and reliable approach, with the saphenous vein graft remaining patent for over 20 years. The 20-year follow-up provides valuable insight into the long-term durability of surgical intervention, allowing for comprehensive assessment of the durability and reliability of this procedure.
冠状动脉瘤（CAAs）并不常见，可导致血栓形成、血管破裂或远端栓塞等并发症。尽管CAAs的定义直径存在争议，但很少被归类为“巨大型”。CAAs的主要病因是动脉粥样硬化疾病。独立来看，CAAs患者估计5年生存率为71%。
我们报告一例56岁女性病例，该患者20年前因胸部感染就诊，检查时听诊发现杂音。随后进行冠状动脉造影，显示右冠状动脉（RCA）广泛动脉瘤形成。切除RCA的动脉瘤段，并使用一段大隐静脉进行重建。20年后，患者因呼吸困难再次就诊，提示需再次检查；冠状动脉造影显示重建术后20年的静脉移植物与天然RCA几乎无法区分。
CAAs的最佳管理策略存在争议，且尚无明确指南。然而，对于巨大冠状动脉瘤（GCAAs）病例，一般首选手术治疗，本病例也是如此。这种重建手术，包括切除RCA的动脉瘤段并用大隐静脉移植物进行重建，被证明是一种持久且可靠的方法，大隐静脉移植物在20多年里一直保持通畅。20年的随访为手术干预的长期耐久性提供了有价值的见解，有助于全面评估该手术的耐久性和可靠性。
