Surgical treatment of a giant right coronary artery aneurysm complicated by massive thrombosis: a clinical case

Abstract

Coronary artery aneurysm is a relatively rare pathology that may be complicated by thrombosis, embolization, or rupture. Giant aneurysms, particularly those containing an intraluminal thrombus, are associated with a high risk of acute coronary events and require timely determination of the optimal treatment strategy.
The aim – to present a clinical case of successful surgical treatment of a giant right coronary artery (RCA) aneurysm complicated by massive intraluminal thrombosis and to justify the choice of aneurysm resection with simultaneous myocardial revascularization.
We describe a 68-year-old patient with comorbidities (arterial hypertension, type 2 diabetes mellitus, and dyslipidemia) who presented with progressive chest pain for three days. The initial evaluation included laboratory tests, electrocardiography, and chest radiography. Coronary angiography with ventriculography was performed to assess the coronary circulation and revealed a giant saccular aneurysm of the proximal RCA measuring up to 50 mm, with a massive thrombus within the aneurysmal cavity. Surgery was performed via median sternotomy under cardiopulmonary bypass. The procedure included coronary artery bypass grafting (to the RCA and the left anterior descending artery), opening of the aneurysm, complete removal of thrombotic masses, resection of the aneurysmal sac, and subsequent closure.
Results. The postoperative period was uneventful. Follow-up echocardiography demonstrated preserved left ventricular systolic function without signs of ischemia. The patient was discharged on postoperative day 8 in stable condition with recommendations for secondary prevention and a plan for follow-up monitoring. Control computed tomography performed one month later confirmed graft patency and the absence of aneurysm recurrence. During 12 months of follow-up, the patient reported no recurrent angina and experienced no cardiovascular events.
Conclusions. Giant RCA aneurysms, particularly those complicated by massive thrombosis, carry a high risk of thromboembolic complications and require an active treatment strategy. Aneurysm resection combined with coronary artery bypass grafting is an effective and safe approach that eliminates a source of embolization and provides adequate myocardial revascularization.