Clinical vignette
Huge right coronary artery aneurysm in a young adult
Kuan-Ming Chiu1, Tzu-Yu Lin2, Ming-Jiuh Wang3*
1Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, 21, Sec. 2, Nan-Ya South Road, Pan Chiao, Taipei 220, Taiwan; 2Department of Anesthesia, Far Eastern Memorial Hospital, 21, Sec. 2, Nan-Ya South Road, Pan Chiao, Taipei 220, Taiwan; 3Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7, Chung Shan South Road, Taipei 100, Taiwan
*Corresponding author. Tel: +886 2 23562010; fax: +886 2 23217522. E-mail address: canon@ha.mc.ntu.edu.tw
A 34-year-old man visited our institution for an abnormal chest radiograph with greatly enlarged cardiac silhouette (Panel A) found before his wedding. Detailed medical history revealed a febrile episode and a strawberry-like tongue and some ‘flu-like symptoms’ for >1 week when he was 5 years old. Diagnostic workup including computerized tomography demonstrated a huge right coronary artery aneurysm (Panel B). Intra-operative transesophageal echocardiography showed a large orifice of right coronary artery with a huge aneurysm (Panel C). The right coronary artery aneurysm was resected (Panel D) under hypothermic cardiopulmonary bypass with cardioplegic arrest. The diameter of the orifice of the right coronary artery was >20 mm, which was closed with Dacron patch, and the saphenous vein was used to bypass the right coronary artery to its two major branches. The patient had an uneventful recovery and was discharged 6 days after the operation.
Panel A. Chest X-ray shows an enlarged cardiac silhouette.
Panel B. Thorax CT-scan shows the right coronary artery aneurysm (white arrows) and its connection (black arrow) with the aorta. MPA, main pulmonary artery.
Panel C. Transesophageal echocardiography shows the enlarged orifice of right coronary artery (small arrow) and the large aneurysm (large arrow).
Panel D. Surgical views of the huge right coronary artery aneurysm (small arrows) and aorta (large arrow).
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