Surgical repair of coronary artery aneurysm after percutaneous coronary intervention

Two cases of coronary artery aneurysm after percutaneous coronary intervent ion are presented. In both cases, follow-up coronary angiography revealed a n expanding saccular aneurysmal formation and restenosis or a new lesion. C onsequently, surgical repair and revascularization were indicated. The intr aoperative angioscope was used to identify the aneurysm, which had not been visible on the heart surface in one case. Its optic fiber light was a usef ul guide, but little information was obtained from direct vision because of the small caliber of the angioscope. Plication of the aneurysm and bypass grafting distal to the aneurysm were performed. A whitish and thick-walled aneurysm was easily found in one case, in which ligation of the aneurysm wa s attempted with added distal bypass. The postoperative course was uneventf ul in both cases, and follow-up angiography showed disappearance of the ane urysm with patent grafts. There was a fragile thrombus inside both the aneu rysmal sacs, which might have caused myocardial infarction and, therefore, justified the surgical repair of the aneurysm with concomitant revasculariz ation.