GIANT RIGHT CORONARY ARTERY ANEURYSM: LIFE-SAVING SURGICAL TREATMENT IN AN UNEXPECTEDLY ASYMPTOMATIC PATIENT

Introduction: Coronary artery aneurysm (CAA) is defined as a dilation exceeding the diameter of an adjacent referent portion by more than 1.5 times. In rare circumstances CAA can be defined as giant, when exceed 8-20 mm. Here we report a rare case of a casual diagnosis of asymptomatic giant right coronary artery aneurysm who underwent successful surgical treatment. Case report: A 66 y.o. male was referred with a giant mediastinic mass revealed at a CT scan. The patient claimed to be asymptomatic. Pre-operative evaluation included: a) TT-Echocardiography showing a big ovalar mass next to the atrioventricular groove with blood flow from RCA; b) Ecg-gated-CTscan which showed a big (14x12.5 cm) contrast-enhanced mass arising from the RCA confirmed at c) coronary angiography. After careful Heart Team evaluation, surgical correction by mean of aneurism ligation, was deemed to be the only treatment option. Surgical Treatment: CPB was established via right axillary artery and peripheral femoral vein cannulation. Median sternotomy allowed the exposition of the huge aneurysm, nourished by the right coronary artery, with a complete dislocation of aorta. Surgical correction included aneurysm incision, exclusion of all communications and ligation. CABG on RCA was not necessary. Following uneventful course, post-operative CT scan showed no evidence of active blood reperfusion to the aneurysmatic remnant. Conclusion: CAAs are rare but potentially catastrophic conditions. Once the diagnosis is made, despite the lack of agreed consensus, early treatment with accurate preoperative evaluation is pivotal in order to optimize the outcome.