Recently, the research outcomes regarding the diagnosis and treatment of a complicated case of coronary aneurysm completed by Department of Cardiovascular Surgery cooperating with multidisciplinary team (MDT) in the First Affiliated Hospital of Xi 'an Jiaotong University (XJTU) were published online in the column of "Flashlight" ofEuropean Heart Journal. This article entitled "Concomitant right coronal aneurysm and total occlusion of left anterior descending artery and left circumflex artery" explicitly illustrated the diagnosis and treatment procedures of coronary aneurysm, especially the selection of surgical strategy and the application of myocardial pathology to unravel the pathogenesis of coronary aneurysm.
Coronary CTA of the patient showed multiple coronary aneurysms complicated with thrombosis, manifested with a giant right coronary aneurysm and severe occlusion of the left anterior descending artery and left circumflex artery. Coronary angiography further confirmed the total occlusion of left anterior descending artery and left circumflex artery, and a giant coronary aneurysm arising from the right coronary artery.
Figure 1. A giant aneurysm arising from the right coronary artery
Considering that no evident diffuse lesions except the giant aneurysm were found in the right coronary artery, it is feasible to perform the coronary aneurysm resection combined with bypass surgery of the right coronary artery. For the total occlusion of left anterior descending artery and left circumflex artery, both PCI and coronary bypass surgery will probably pose high risk because diffuse lesions and multiple beaded tumor-like dilatation can be observed in both arteries. Therefore, Department of Cardiovascular Surgery cooperated with MDT to deliver collective consultation, analyzed the disease condition in combination with medical history and auxiliary examination results. After obtaining the informed consent from the patient, the surgical regime of coronary aneurysm resection with bypass surgery was eventually determined. The remaining left coronary arteries were temporarily left untreated. The surgery was successfully performed. Postoperatively, ventilator-assisted ventilation, closed mediastinal drainage, anti-coagulation, anti-infection and oral medication were delivered. The patient was physically stable at 1-year follow-up.
Figure 2. Left panel shows a giant aneurysm from the right coronary artery during open-heart surgery;
right panel displays the right coronary artery after coronary bypass surgery
To further unravel the pathogenesis, pathological examination was performed. However, the specific mechanism of chronic inflammatory changes remains elusive according to pathological findings combined with medical history and laboratory examination results.
Figure 3. Pathological examination after the resection of the right coronary aneurysm
The First Affiliated Hospital of XJTU is the first and corresponding affiliation of this article. Professor Yan Yang and Professor Li Yongxin from Department of Cardiovascular Surgery are co-corresponding authors. This project was successfully accomplished under the assistance from Professor John D. Day, Chairman of Heart Rhythm Society, colleagues from Department of Pathology, Department of Nephrology and Department of Medical Imaging of our hospital, and Department of Pathology of College of Medicine & Forensics of XJTU. This project was financially supported by Surface Project of Clinical Research Center of our hospital (XJTU1AF-CRF-2018-015) and Key Research and Development Project of Department of Science and Technology of Shaanxi Province. This is the second time that the team led by Professor Yan Yang published an article in European Heart Journal since the first publication inEuropean Heart Journal-Case Reports, an affiliated journal ofEuropean Heart Journalin the year of 2019.
