# Multiple Giant Coronary Artery Aneurysms With a Coronary Pulmonary Artery Fistula: A Case Report

## TL;DR

A rare case of multiple giant coronary artery aneurysms and a fistula was successfully treated surgically without revascularization.

## Contribution

A novel surgical approach for complex multiple giant coronary artery aneurysms with a coronary pulmonary artery fistula is reported.

## Key findings

- Multiple giant coronary artery aneurysms were successfully treated on a beating heart without revascularization.
- Postoperative imaging confirmed the absence of blood flow in the aneurysms and abnormal vessels.
- The surgical technique involved direct echocardiography and ligation of feeding vessels.

## Abstract

Coronary artery aneurysms (CAAs) are rare. Giant CAAs are defined as those exceeding 2 cm in diameter. An 82-year-old woman was referred to our institution for surgery after coronary 3D computed tomography (CT) and transthoracic echocardiography (TTE) revealed CAAs and a coronary-to-pulmonary artery fistula. Coronary angiography identified four aneurysms, ranging from 10 to 45 mm in diameter, in the right coronary artery (RCA), left anterior descending (LAD) artery, and left circumflex (LCx) artery. The Qp/Qs ratio was 1.34. The surgical approach involved median sternotomy and was performed under cardiopulmonary bypass (CBP) on a beating heart. The aneurysms originating from the RCA and LAD artery measured 30 and 45 mm, respectively, and were easily visible. After isolating the feeding vessels, the aneurysms were opened, and their inflow and outflow vessels were sutured closed. Additionally, the feeding vessels were ligated at their origins, and the aneurysm walls were sutured. The locations of the small aneurysms were confirmed using direct echocardiography and treated similarly. There were no signs of damage to the normal coronary arteries, and revascularization was not required. The fistula was closed after opening the pulmonary artery. The patient was weaned off CBP without difficulty, and her postoperative course was uneventful. Postoperative 3D CT confirmed the disappearance of blood flow in the aneurysms and abnormal vessels. We report a case of multiple CAAs with complex feeding vessels that were successfully treated on a beating heart without revascularization.