Images in Cardiothoracic Medicine and Surgery
Incidental finding of a large right coronary artery aneurysm
Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(3) 344–345 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492313516778 aan.sagepub.com
Elsayed M Elmistekawy1, Luc Beauchesne2 and Theirry Mesana1
Figure 1. Two-dimentional 4-chamber echocardioghraphy showing a 4 4-cm mass (arrow) that represented a thrombosed right coronary artery aneurysm. LA: left atrium, LV: left ventricle; RA: right atrium; RV: right ventricle.
Figure 3. Surgical view from the top of operating table, showing the exposed heart through a median sternotomy. There is a 4 4-cm mass in the atriovantricular groove (arrow) between the right atrium and right ventricle.
Figure 2. (A) Contrast-enhanced non-gated computed tomography revealing a low-density non-enhancing lesion in the right atrioventricular groove (arrow) medial to the mid right coronary artery (arrowhead). (B) Curved multiplanar reformatted maximumintensity projection image from the same computed tomography scan, showing the right coronary artery draped around and entering (arrow) as well as exiting (arrowhead) the low-density mass-like lesion.
A 45-year-old woman, known to have systemic lupus erythematosus, presented with congestive heart failure. Echocardiography revealed severe aortic regurgitation, moderate calcified mitral stenosis, and severe mitral regurgitation. Echocardiography showed a 3 3-cm round heterogeneous structure (possibly a vascular structure with thrombus) in the right atrioventricular groove (Figure 1). Sagittal reconstruction of chest computed tomography revealed a 4 3.8 4-cm mass-like
1 Department of Cardiac Surgery, The Ottawa Hospital, University of Ottawa, Canada 2 Departments of Cardiology, The Ottawa Hospital, University of Ottawa, Canada
Corresponding author: Thierry Mesana, Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada. Email: [email protected]
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lesion in the proximal right atrioventricular groove, immediately inferior to the origin of the right coronary artery (RCA) and medial to the mid RCA, suspected to be a thrombosed RCA aneurysm (Figure 2). Coronary angiography revealed no significant coronary disease in a left-dominant system, and a blocked nondominant RCA. The patient underwent a successful double-valve replacement (aortic and mitral). Intraoperatively, the RCA giant aneurysm was identified at the atrioventricular groove, approximately 5 3 cm in size (Figure 3); it was left untouched because the RCA was nondominant and occluded proximal to the already thrombosed aneurysm.
Acknowledgment The authors thank Dr. Sean Dickie, MD, FRCPC (Anesthesiology Department) and Carole Dennie, MD (Cardiac Imaging Department).
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest statement None declared.
Downloaded from aan.sagepub.com at ORILLIA CAMPUS LRC on March 14, 2015
Incidental finding of a large right coronary artery aneurysm
Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(3) 344–345 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492313516778 aan.sagepub.com
Elsayed M Elmistekawy1, Luc Beauchesne2 and Theirry Mesana1
Figure 1. Two-dimentional 4-chamber echocardioghraphy showing a 4 4-cm mass (arrow) that represented a thrombosed right coronary artery aneurysm. LA: left atrium, LV: left ventricle; RA: right atrium; RV: right ventricle.
Figure 3. Surgical view from the top of operating table, showing the exposed heart through a median sternotomy. There is a 4 4-cm mass in the atriovantricular groove (arrow) between the right atrium and right ventricle.
Figure 2. (A) Contrast-enhanced non-gated computed tomography revealing a low-density non-enhancing lesion in the right atrioventricular groove (arrow) medial to the mid right coronary artery (arrowhead). (B) Curved multiplanar reformatted maximumintensity projection image from the same computed tomography scan, showing the right coronary artery draped around and entering (arrow) as well as exiting (arrowhead) the low-density mass-like lesion.
A 45-year-old woman, known to have systemic lupus erythematosus, presented with congestive heart failure. Echocardiography revealed severe aortic regurgitation, moderate calcified mitral stenosis, and severe mitral regurgitation. Echocardiography showed a 3 3-cm round heterogeneous structure (possibly a vascular structure with thrombus) in the right atrioventricular groove (Figure 1). Sagittal reconstruction of chest computed tomography revealed a 4 3.8 4-cm mass-like
1 Department of Cardiac Surgery, The Ottawa Hospital, University of Ottawa, Canada 2 Departments of Cardiology, The Ottawa Hospital, University of Ottawa, Canada
Corresponding author: Thierry Mesana, Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada. Email: [email protected]
Downloaded from aan.sagepub.com at ORILLIA CAMPUS LRC on March 14, 2015
Elmistekawy et al.
345
lesion in the proximal right atrioventricular groove, immediately inferior to the origin of the right coronary artery (RCA) and medial to the mid RCA, suspected to be a thrombosed RCA aneurysm (Figure 2). Coronary angiography revealed no significant coronary disease in a left-dominant system, and a blocked nondominant RCA. The patient underwent a successful double-valve replacement (aortic and mitral). Intraoperatively, the RCA giant aneurysm was identified at the atrioventricular groove, approximately 5 3 cm in size (Figure 3); it was left untouched because the RCA was nondominant and occluded proximal to the already thrombosed aneurysm.
Acknowledgment The authors thank Dr. Sean Dickie, MD, FRCPC (Anesthesiology Department) and Carole Dennie, MD (Cardiac Imaging Department).
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflict of interest statement None declared.
Downloaded from aan.sagepub.com at ORILLIA CAMPUS LRC on March 14, 2015
