Right Coronary Artery Aneurysm 

Author: Fawwaz Shah, MD
Institution: University of Washington
Date Reviewed: January 2014
Learning Domain: Adult Cardiac Surgery
Learning Objective: Evaluation and Management of Coronary Artery Aneurysms
PowerPoint File: Right Coronary Artery Aneurysm

 

Discussion Points

  • Natural History of CA Aneurysms?
  • What if this Pt did not have LAD disease?
  • Risk of RV Injury with Ligation
  • Open vessel or simply ligate both ends
  • Role of Intracoronary  Intervention 
  • What if Patient were in Japan?

 

Coronary artery aneurysms

  • Comprises mostly of case reports.
  • 0.02-0.04% incidence (Surgical). 
  • 0.15%-4.9% incidence (Angiographic)
  • No clear consensus regarding natural history/sequelae.
  • Risks: rupture, compression, fistulization, embolization, thrombosis, myocardial infarction.
  • Individual characteristics often dictate treatment strategies.

 

Etiology

  • Varies geographically.
  • Europe and NA: > 50% associated with atherosclerotic disease.
  • Japan/China: Kawasaki’s disease most common.
  • Other etiologies include congenital, iatrogenic and infectious (mycotic).
  • 55% associated with the RCA.

 

Learning Points

  • CAA: coronary dilation 1.5 times the diameter of the nearest normal adjacent segment or largest coronary vessel. (“Giant CAA” are defined as > 2cm.)
  • Principle of management is to exclude the aneurysmal segment and maintain coronary blood flow.