Non-Atherosclerotic Giant Right Coronary Artery Aneurysm in a Patient with a History of Aortic Valve Replacement: A Case Report and Review of the Literature
Halil İbrahim Tanrıseven, Hüsnü Değirmenci* and Gökhan Yıldız
ABSTRACT
Objective: To present a case of an isolated, non-atherosclerotic giant right coronary artery (RCA) aneurysm detected in a patient with a history of aortic valve replacement (AVR) surgery, and to discuss the underlying etiopathogenesis in light of current literature.
Case Presentation: A 48-year-old male patient presented to the outpatient clinic with complaints of compressive chest pain radiating to the left arm, numbness, and episodic palpitations, which occurred independently of physical exertion. His medical history was notable for a prior AVR operation. The patient’s electrocardiogram revealed no acute ischemic changes, and cardiac troponin I levels were negative. Echocardiographic evaluation demonstrated a structurally and functionally intact prosthetic valve with a preserved left ventricular ejection fraction (LVEF) of 60%. Diagnostic coronary angiography, performed with a preliminary diagnosis of unstable angina pectoris (USAP), revealed an entirely normal left coronary system (LAD and LCx) completely devoid of intraluminal atherosclerotic plaques (Figure 1). However, quantitative coronary angiography (QCA) of the proximal segment of the RCA revealed a giant fusiform aneurysm measuring 17.0 mm x 33.9 mm (Figure 2). Following a comprehensive evaluation by the multidisciplinary Heart Team, the patient was placed under close clinical surveillance with optimized medical therapy.
Conclusion: The angiographically pristine appearance of the left coronary system provides compelling evidence that the giant aneurysm in the proximal RCA is non-atherosclerotic in origin. The most plausible underlying pathophysiological mechanism is iatrogenic ostial or vascular injury sustained secondary to the previous AVR surgery.
