Giant Coronary Artery Aneurysms With Coronary Sinus Fistula: Forget the Distal Bypass

We describe the surgical approach for 2 symptomatic patients with coronary artery aneurysms with coronary sinus fistulas. One patient presented as an elective procedure secondary to concerns for aneurysmal growth and rupture; the second patient presented in cardiogenic shock from excessive shunting and right heart failure. Historically, coronary aneurysms have mandated ligation with distal bypass. Wwe report that successful treatment of this condition can be performed with ligation alone because of the significant collateral circulation present in these adult patients.