JTCVS Techniques | 2021
Commentary: Are coronary aneurysms surgical disease?
Abstract
Because the available surgical knowledge and the contemporary guidelines are limited with respect to aneurysmal coronary diseases, this case report provides an excellent opportunity to learn more about this entity. Although we typically encounter coronary aneurysms in a mild-to-moderate (ie, ectatic) form accompanying stenotic coronary disease for coronary artery bypass grafting consultations without a need of aneurysm repair, larger aneurysms may require interventions. The key surgical principles are aneurysm exclusion and distal bypass. Aneurysmal exclusion with inflow and outflow ligation can be challenging. In the present case, the authors performed the proximal occlusion by pericardial patch closure of the left main ostium; however, residual flow within the excluded aneurysm was noted. Incising the aneurysm provides excellent access to potential sites of inflow, although the calcified nature of the presented aneurysms might have prohibited this approach. Total arterial revascularization to the distal arteries, as done in this case, may provide long-term survival benefit. Especially in pediatric cases, arterial grafting should be considered to further accommodate somatic growth. If ligation of a mild or moderate aneurysmal proximal artery is not performed, saphenous vein grafting may be a choice to overcome competitive flow. Adding to the excellent discussion in this article, the literature suggests that coronary fistulas could be a cause of aneurysm formation due to persistent high flow in the coronaries. This condition is most often congenital, although it