# Giant right coronary artery aneurysm with associated dissection: diagnosis and surgical management

## TL;DR

This paper describes a rare case of a giant right coronary artery aneurysm in an elderly woman and the surgical steps taken to manage it.

## Contribution

The paper presents a unique case of a giant coronary artery aneurysm with dissection and its successful surgical management.

## Key findings

- The patient had an 85 mm giant right coronary artery aneurysm causing pericardial irritation and right heart compression.
- Surgical resection and bypass using a saphenous vein graft were performed, revealing a dissected aneurysm wall at risk of rupture.
- The case emphasizes the need for timely diagnosis and surgical intervention in managing giant coronary artery aneurysms.

## Abstract

Coronary artery aneurysms are defined as a focal dilatation exceeding 1.5 times the diameter of the adjacent normal segment. They are found in up to 5% of patients undergoing coronary angiography. Giant coronary artery aneurysms (GCAAs), typically defined as >20 mm in diameter, with an incidence of ⁓0.02%. We present the case of an 82-year-old female who underwent coronary artery bypass grafting due to a giant right coronary artery aneurysm measuring 85 mm, identified on preoperative contrast-enhanced computed tomography (CT). The patient exhibited symptoms consistent with pericardial irritation secondary to aneurysms size and was found to have significant right heart compression. Surgical intervention included opening and resection of the aneurysmal sac and bypassing the affected segment using a saphenous vein graft. Intraoperatively, it was discovered that the aneurysm wall was dissected, with a high risk of rupture. This case highlights the importance of timely recognition and surgical management of GCAAs.