https://orcid.org/0000-0001-5171-9259
A 27-year-old woman underwent transthoracic echocardiography for palpitations due to frequent premature ventricular beats, as documented at 24 h electrocardiogram monitoring.
Echocardiography showed moderate left and right ventricle (RV) dilatation with good bi-ventricular systolic function; the presence of right coronary sinus dilation was noted (arrow, panel A), and a great spherical sac (3.9 × 4.8 cm) filled with high-velocity swirling Colour Doppler, at the right atrio-ventricular junction (arrow, panel B). This appeared connected through a fistulous tract (panel C, arrow) to the right ventricular inlet. Findings were consistent with giant right coronary artery aneurysm and right ventricular fistula. Panels D–F and Supplementary material online, video SD show 3D angio-CT reconstructions of the aneurysm in its anterior, right lateral, and diaphragmatic aspects, respectively. The proximal right coronary artery (RCA) was tortuous and markedly dilated (up to 24 mm); the aneurysm (An.) reached a maximal diameter of 55 mm, and was connected to the RV inlet with a fistula (Fist.) measuring 25 mm in length and 15 mm in diameter. An acute marginal branch (a.m.b.) originated just above the aneurysm, while two postero-lateral branches originated apparently from it. A subtle posterior inter-ventricular branch originated distally from the aneurysm. Both the anterior descending artery and the circumflex coronary artery were normal in size and morphology.
Surgical treatment consisted of the exclusion of the aneurysmatic right coronary, restoration of the coronary sinus with a dacron patch, closure of the fistula, and three saphena-vein coronary bypass for RCA branches. Interestingly, one of them was directed to a chamber created by the surgeon from a tract of the aneurysm containing the ostia of three distal branches, which could not be singularly treated.
Supplementary data are available at European Heart Journal – Cardiovascular Imaging online.
Acknowledgements
The authors thank Gianni Troise, MD, Director of Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy.
Author notes
Conflict of interest: None declared.
