Coronary artery aneurysm

case report of surgical repair of an anterior descending coronary artery aneurysm associated with myocardial revascularization

Abstract

Coronary artery aneurysm is an uncommon vascular abnormality characterized by abnormal dilatation of a coronary segment and associated with a wide spectrum of clinical presentations, ranging from incidental findings to myocardial ischemia, thrombosis, distal embolization, or the need for surgical intervention. We report the case of a 47-year-old male patient with a history of systemic arterial hypertension, arrhythmia, venous insufficiency, and previous cranioplasty after traumatic brain injury, on chronic use of carbamazepine, acetylsalicylic acid, and rivaroxaban, who underwent major cardiac surgery for correction of a coronary artery aneurysm associated with myocardial revascularization under cardiopulmonary bypass. The procedure was performed under general anesthesia, with invasive monitoring and support appropriate for the complexity of the intervention. Intraoperatively, median sternotomy, cardiopulmonary bypass, surgical correction of the aneurysm, myocardial revascularization, epicardial pacemaker implantation, thoracic and pericardial drainage, and layered closure were performed. Intraoperative images sequentially documented surgical exposure, progressive dissection of the aneurysmal segment, its intraoperative approach during repair, and the final aspect after vascular reconstruction. Postoperatively, the patient was transferred to the intensive care unit receiving low-dose dobutamine, with transient norepinephrine requirement, and evolved with hemodynamic stability, successful ventilatory weaning, preserved renal function, and no major immediate complications. This case reinforces the importance of individualized perioperative planning in patients with coronary artery aneurysm, highlighting the role of the anesthesiologist in cardiovascular risk assessment, maintenance of hemodynamic stability, management of the balance between myocardial oxygen supply and demand, and safe transition to intensive care.