Surgical management of arteriosclerotic coronary artery aneurysm

A 60-year-old man suffered antero-septal myocardial infarction at the age o f 56. Coronary angiography demonstrated total occlusion of the left anterio r descending artery and a large saccular aneurysm of the right coronary art ery. Diffuse coronary ectasia was also shown in the right coronary artery a djacent to the aneurysm. Despite anticoagulant therapy, the aneurysm formed a thrombus and developed coronary artery stenosis distal to the aneurysm. Ligation of the aneurysm and in situ gastroepiploic artery grafting were pe rformed. Sudden heart failure was developed during skin closure. As this co ndition was considered to be graft hypoperfusion, supplemental saphenous ve in grafting was placed. Ligation is a simple, reliable technique to prevent future complications for a large saccular right coronary artery aneurysm, however, gastroepiploic artery might be an inappropriate bypass conduit for the ligated coronary artery with diffuse ectasia.