A Case of Multiple Coronary Artery Aneurysms Associated with Bilateral Coronary-Pulmonary Artery Fistulae

(Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan and Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center*, Kyoto, Japanj

Nozomu Sasahashi* Toshifumi Takeuchi Masahira Fukuoka
A case of multiple coronary artery aneurysms associated with bilateral coronary-pulmonary artery fistulae is described. A 60-year-old man was found to have a continuous heart murmur. Plain chest X-ray showed mild cardiomegaly and an abnormal shadow at the left periphery of the heart. Enhanced chest CT revealed multiple round masses around the main pulmonary artery. Cardiac catheterization studies confirmed the presence of a left-to-right shunt of 26% at the site of the main pulmonary artery, with a pulmonary-to-systemic flow ratio of 1.35: 1. Coronary angiography revealed multiple coronary artery aneurysms associated with bilateral coronary-pulmonary artery fistulae and an abnormal coronary artery adjacent to the right coronary artery. Mild aortic regurgitation was also noted on ascending aortography. On February 10, 2006, surgical intervention was undergone. The maximum diameter of the coronary artery aneurysms was 4cm and the aneurysmal wall was very thin. Dilated abnormal vessels connected with the aneurysms were also noted. Under complete cardiopulmonary bypass, extirpation of the aneurysms and ligation of the abnormal vessels were performed. Although the main pulmonary artery was opened to inspect the draining portion from the fistula, the orifice could not be confirmed. The aortic valve was replaced with a mechanical prosthesis. Histopathological findings of the excised specimen included fibrosis, myxoid change, and calcification. The postoperative clinical course was uneventful, and no residual mass was noted on chest CT. The patient was discharged on the 14th postoperative day.
@Jpn. J. Cardiovasc. Surg. 36: 137-140 (2007)