Sick Sinus Syndrome Induced by Giant Coronary Artery Aneurysm Rupture in a Patient with Constrictive Pericarditis

Multiple coronary artery aneurysms (CAA) with a giant CAA are rare. Patient with a giant CAA is at risk of thrombosis, aneurysm rupture and even sudden cardiac death. We reported a case of a 78-year-old woman having a giant CAA (43 mm × 37 mm) of proximal left anterior descending artery as well as multiple small CAA of both left and right coronary arteries. The spontaneous rupture of the giant CAA combined with previously undiagnosed constrictive pericarditis leaded to severe dyspnea, edema of lower extremities, and syncope. Emergency electrocardiogram (ECG) showed remarkable sinus bradycardia, sinus arrest and atrioventricular junctional rhythm, indicating sick sinus syndrome. Temporary cardiac pacemaker therapy was performed urgently to avoid sudden cardiac death. Multiple non-invasive imaging tests revealed constrictive pericarditis possibly caused by tuberculosis, and giant CAA with the possibility of rupture. Then pericardiotomy and resection of giant aneurysm were performed urgently. Postoperative course was uneventful. The patient became asymptomatic and was discharged in good health. To the best of our knowledge, this is the first case of spontaneous rupture of giant CAA in a patient with constrictive pericarditis, with a rare complication of sick sinus syndrome. of proximal left anterior descending artery with multiple small CAA of both left and right coronary arteries (Figure 2C). We considered the possibility of aneurysm rupture. Thus median sternotomy and pericardiotomy were performed urgently. The operation revealed significant pericardial thickening (3-5 mm), extensive pericardial adhesions, hemopericardium and aneurysm rupture. There was no obvious atherosclerotic lesions and thrombus in the giant aneurysm. Surgical exploration found the giant aneurysm having four malformed fed arteries from both left and right coronary arteries. Then the adhesions of pericardium were lysed, the fed arteries were ligated, and the giant aneurysm was resected (Figure 3). We did not consider bypass graft in this patient, because there were many small aneurysms Yang Liu1,2#, Ping Hua3#, Jie Chen2, Huan-Ji Zhang1,2, Wei-Feng Sun1, Rong Zou2, Hui Huang1,2*, Jing-Feng Wang1,2* 1Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120 China 2Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Guangdong Province, Guangzhou, 510120 China 3Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120 China #These authors equally contributed *Address for Correspondence Hui Huang, MD, PhD, Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, China 510120, Tel: 0086-20-81332475; Fax: 0086-20-81332623; E-mail: [email protected] Jing-Feng Wang, MD, PhD, Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, China 510120, Tel: 0086-20-81332475; Fax: 0086-2081332623; E-mail: [email protected] Submission: 29 January, 2014 Accepted: 19 February, 2014 Published: 24 February, 2014 Reviewed & Approved by: Dr. Xiaojie Xie, Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, China Case Report Open Access