Surgical Management of Giant Coronary Artery Aneurysms with Associated Fistula

Giant coronary artery aneurysms with fistulas are rare and associated with risk of rupture.1 Fistulas with large left-to-right shunting can be complicated by congestive heart failure, aneurysms, endocarditis, or embolization with myocardial infarction. Because of these significant complications, surgery or intervention with transcatheter closure is recommended in symptomatic patients.

From July 1963 to 2007, Dr. Howell performed 30,000 cardiac or vascular operations at The Methodist Hospital. Among these, three patients who had giant coronary artery aneurysms with fistulas underwent surgical correction. Surgical strategies for correction included aneurysm resection and fistula closure, coronary reconstruction, coronary artery bypass, primary ligation, and hybrid therapy involving aneurysm ligation and transcatheter embolization.