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首页> 外文期刊>European Heart Journal - Case Reports >A giant right coronary artery aneurysm caused by congenital coronary fistula
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A giant right coronary artery aneurysm caused by congenital coronary fistula

机译：先天性冠状动脉瘘引起的巨型右冠状动脉动脉瘤

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A 61-year-old man presented to the outpatient clinic with a 3-month history of increasing dyspnoea on exertion. A chest radiograph and computed tomography demonstrated a greatly enlarged cardiac silhouette ( Figure ), and echocardiography revealed the presence of a large blood-filled sac markedly compressing the right heart chambers. Computed tomographic angiography of the coronary artery confirmed the presence of a giant saccular aneurysm that involved the entire right coronary artery and had a maximum diameter of 13.7?cm. The aneurysm originated from the opening of the right coronary artery; there was no evidence of coronary plaques, wall calcification, or thrombus formation. The distal right coronary artery was connected to the inferior wall of the left ventricle near the mitral annulus through a 1.2 cm fistula. Owing to the severity of his right heart compression and the possibility of aneurysm rupture, the patient was referred for surgery ( Figure ). The distal fistula of the right coronary artery was repaired with an autologous pericardium patch under cardiopulmonary bypass. The aneurysm was then resected, and the right coronary artery was reconstructed. Oral anticoagulation was initiated after surgery and has continued post-discharge. On histological examination, a coronary artery aneurysm was confirmed with widespread smooth muscle hyperplasia and mucoid degeneration in the media. Post-operative coronary computed tomography angiography showed a regressed aneurysmal sac, and the patient was discharged without clinical symptoms. Coronary artery aneurysms are uncommon, and giant coronary artery aneurysms (50?mm) are extremely rare, affecting 0.02% of patients undergoing coronary angiography. Management of these giant aneurysms is challenging, and the optimal method is not well-established because of the rarity of the condition and the reliance on evidence-based largely on case reports. Surgical ligation is not generally indicated but should be considered for large aneurysms with evidence of compression or recurrent thrombosis. Figure 1 Two-dimensional view of coronary computed tomography demonstrated a greatly enlarged cardiac silhouette. Figure 1 Two-dimensional view of coronary computed tomography demonstrated a greatly enlarged cardiac silhouette. Figure 2 The giant right coronary artery aneurysm during the surgery. Figure 2 The giant right coronary artery aneurysm during the surgery. Supplementary material is available at European Heart Journal - Case Reports online. Acknowledgements The authors appreciate the multiple contributions made by and advice from Ge Gao, Linlin Li, Zhaoji Zhong, Ying Meng, and Xinyu Wang (Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People’s Republic of China). Consent: The author/s confirm that written consent for submission and publication of this case report including image(s) and associated text has been obtained from the patient in line with COPE guidance. Conflict of interest: none declared. References 1 Tamene AM , Saxena R , Grizzard JD , Shenoy C. Asymptomatic progression of an atherosclerotic giant right coronary artery aneurysm over 12 years: characterization using cardiovascular magnetic resonance and computed tomography imaging . Circulation 2015 ; 131 : e360 – e362 . 2 Citro R , Iuliano G , Baldi C , Iesu S. A time bomb defused, in time! Incidental giant right coronary artery aneurysm . Eur Heart J 2019 ; 40 : 2619 . 3 Arboine L , Palacios JM. Left main coronary artery aneurysm . N Engl J Med 2018 ; 378 : e32 .
机译：一名61岁的男子介绍了门诊诊所，历史增加了呼吸困难的历史。胸部射线照片和计算机断层扫描显示出大大放大的心脏轮廓（图），并且超声心动图显示出大型血液填充的囊的存在，显着压缩右心室。冠状动脉的计算机断层血管造影证实了涉及整个右冠状动脉的巨型囊状动脉瘤的存在，并且最大直径为13.7Ωcm。动脉瘤起源于右冠状动脉的开口;没有证据表明冠状动脉斑块，墙壁钙化或血栓形成。远端右冠状动脉通过1.2cm瘘管连接到左心室的左心室的下壁。由于他的右心压迫和动脉瘤破裂的可能性，患者被提及手术（图）。右冠状动脉的远端瘘管在心肺旁路下用自体心包贴剂进行修复。然后切除动脉瘤，重建右冠状动脉。手术后启动口腔抗凝，并持续后出院。在组织学检查中，在培养基中含有广泛的平滑肌增生和粘液变性，确认了冠状动脉动脉瘤。术后冠状动脉的冠状动脉造影血管造影显示出退化的动脉瘤囊，患者没有临床症状。冠状动脉动脉瘤是罕见的，巨型冠状动脉动脉瘤（>50μm）非常罕见，影响冠状动脉造影的患者的0.02％。这些巨大动脉瘤的管理是具有挑战性的，并且由于条件的罕见和依赖于案例报告，最佳方法是不熟悉的。通常不指示手术连接，但应考虑具有压缩或复发性血栓形成的迹象的大动脉瘤。图1冠状动脉计算机断层扫描的二维视图显示了一个大大放大的心脏轮廓。图1冠状动脉计算机断层扫描的二维视图显示了一个大大放大的心脏轮廓。图2手术期间巨型右冠状动脉动脉瘤。图2手术期间巨型右冠状动脉动脉瘤。欧洲心脏杂志提供补充材料 - 在线报告。致谢作者欣赏GE GAO，Linlin Li，Zhaoji中，盈梦和新余王（富亚医院，中国医学科学院，中国医学科学院，北京北京市医学院富巾医院，中华人民共和国）。同意：作者/■确认书面同意提交和公布本案例报告，包括图像和相关文本，符合应对指导。利益冲突：没有宣布。参考文献1 Tamene AM，Saxena R，Grizzard JD，Shenoy C.滴眼症巨型右冠状动脉动脉瘤的无症状进展超过12年：使用心血管磁共振和计算机断层扫描成像进行表征。 2015年流通; 131：E360 - E362。 2 Citro R，Iuliano G，Baldi C，IESU S.时代炸弹，及时挫败！偶然巨型右冠状动脉动脉瘤。 EUR Eart J 2019; 40：2619。 3 Arboine L，Palacios JM。左主要冠状动脉动脉瘤。 n Engl J Med 2018; 378：E32。

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