Giant aneurysm in coronary artery fistula.

rom the Departments f *Cardiology and Cardiovascular Surgery, okohama Minami Kyosai ospital, Yokohama, Japan; nd the ‡Department of ardiovascular Medicine, okyo Medical and Dental niversity Graduate School, okyo, Japan. anuscript received uly 10, 2009; ccepted July 14, 2009. A69-year-old woman was referred to our hospital with dyspnea. The chest X-ray (A) was notable as a mass shadow. A transthoracic echocardiogram revealed a mosaic pattern in the pulmonary artery (PA). Multislice computed tomographic angiography and coronary angiography showed the giant aneurysm in the coronary artery fistula arising from the left main coronary trunk (LMT) and entering in the PA (B, Online Video 1). The aneurysm measured 55 45 mm with calcification and thrombus formation (C). Cardiac catheterization revealed an oximetry step-up of 9% at the main PA, and a left-to-right shunt of 1.84:1 (Qp:Qs) was found. Aneurysmorrhaphy and closure of the fistula outlet from the PA was performed (D), and the symptom disappeared. In this case, a giant aneurysm was produced in coronary fistulas, which may be associated with a worse prognosis in hemodynamics (1), probably due to a coronary steal phenomenon. ublished by Elsevier Inc. doi:10.1016/j.jacc.2009.07.052