PMC6136512_01
A 3D reconstruction image of the heart. In (a), the white arrows show the left coronary system with aneurysmal main stem and LAD (black arrows) and circumflex artery. In (b), the black arrows show the spherical giant aneurysm of the RCA which measures more than four centimeters.
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The 3D reconstruction images obtained from the CT angiogram revealed the very interesting morphology of these GCAAs which was clinically overlooked in echocardiography at the acute assessment (Figure 1).
Intraoperative images. The black arrows in (a) show the giant CAA which is larger than the nearby aortic root (Ao) and the right atrium (RA). In (b), the RCA aneurysm is dissected open, and after thrombus debridement, the stenotic vessel lumen is indicated with a black arrow in (c). In (d), the main stem and LAD are dissected open and endarterectomy is performed. In (e), the atherosclerotic cast is measured before it was sent for histopathology and microbiology investigations.
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Upon opening the pericardium, the operating field was dominated by large-sized coronaries and especially the RCA one which appeared larger than the aortic root (Figure 2(a)). All aneurysms were sequentially dissected open starting with the largest RCA (Figure 2(b)). Thrombus material and calcified plaques were removed (Figure 2(c)). The LAD was dissected open distally to the stem, and endarterectomy was performed to provide an area for distal anastomosis (Figure 2(d)). A large calcified cast was sent for investigation (Figure 2(e)). Interestingly, all the distal vessel lumens had postaneurysmal stenosis as shown on Figure 2(c).