Hybrid Treatment of Multiple Coronary Aneurysms with a Pulmonary Artery Fistula

Abstract

A computed tomography (CT) scan was performed for a man in his 60s to investigate a continuous murmur. An 18-mm coronary aneurysm with a fistula with the pulmonary artery was found on the anterior aspect of the main pulmonary artery (MPA),and a 10-mm coronary aneurysm was found on the lateral aspect. Abnormal inflow vessels originating from the right sinus of Valsalva and the left anterior descending artery (LAD) formed a complicated network around the MPA. Although the patient was asymptomatic, the aneurysms were saccular and considered to be an indication for surgery to prevent rupture. In addition, heart failure, embolism, and myocardial ischemia could be prevented by treatment. We planned a hybrid therapy of open surgery and percutaneous coil embolization. Surgical repair was performed through a median sternotomy. The abnormal vessel originating from the right sinus of Valsalva was ligated under cardiopulmonary bypass. After cardiac arrest, the 18-mm aneurysm located on the anterior surface of the MPA was incised and the orifice of the fistula and inflow vessels were closed from the inside of the aneurysm. The anomalous vessels originating from the LAD and the 10-mm aneurysm on the lateral aspect of the MPA were located near the LAD; therefore, we avoided surgical repair of these lesions. An additional percutaneous coil embolization was performed postoperatively for the remaining lesions. A post-embolization CT scan showed no residual aneurysms or fistula. A hybrid treatment may be a useful method to reduce the risk of complications of each therapy for reliable closures of fistula and aneurysms.