Giant Sinoatrial Nodal Artery Aneurysm with Fistula into the Right Atrium Treated by Partial Resection and Plication: A Case Report

Usha Kumari; Mansoor Rahman; Muneeb Ullah Jan; Salecah Rahmat Ullah; Fakhar Abbas; Zara Shirazi; Salim Surani

doi:10.18502/jthc.v18i2.13325

Usha Kumari Dow University of Health Sciences, Karachi, Pakistan.
Mansoor Rahman Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan.
Muneeb Ullah Jan Department of Cardiology, Lady Reading Hospital, Peshawar, Pakistan.
Salecah Rahmat Ullah Central Michigan University Hospital Saginaw, USA.
Fakhar Abbas King Edward Medical University, Lahore, Pakistan.
Zara Shirazi Department of Cardiac Surgery, National Institute of Cardiovascular Disorders, Pakistan.
Salim Surani Department of Pulmonary, Critical Care & Sleep Medicine, Texas A&M University, Texas, USA.

DOI: https://doi.org/10.18502/jthc.v18i2.13325

Keywords: Aneurysm, false; Coronary aneurysm; Right atrium; Coronary angiography

Abstract

Coronary artery aneurysms (CAAs) occur when an artery dilates 1.5 times the reference vessel. They occur most commonly because of atherosclerosis. CAAs are a rare phenomenon, and it is even rarer to find a giant CAA, which is roughly defined as a size 400% above the reference vessel. Giant CAAs are commonly found in the right coronary artery. The sinoatrial nodal artery (SNA) is among the least common sites for CAA involvement. Sometimes, communication exists between the aneurysm and a chamber of the heart or a great vessel. The consequences of the fistula depend on its size. Because of the rarity of the condition, guidelines are not well developed. However, small CAAs can be managed conservatively, whereas giant CAAs require resection, ligation, and bypass grafting. CAAs have a predilection for males and the elderly. We describe a 40-year-old South Asian woman presenting with mild dyspnea on exertion of 1 year’s duration. Echocardiography showed a 60×60 mm cystic sac, subsequently confirmed by computerized tomography, which showed 3 large aneurysms (70×61 mm) and 3 small aneurysms in the SNA. Coronary angiography illustrated that the SNA branched off the left main coronary artery, and the aneurysm communicated with the right coronary artery. The aneurysm was partially resected and plicated.