DISCUSSION
This patient had a right CAA and CAE of LAD and LCX. He experienced
sudden onset retrosternal chest pain at rest without any exacerbating
activity with no prior episode. Initially, he was suspected to be a case
of myocardial infarction, but on complete workup, an aneurysm of the
right coronary artery was the main culprit causing the symptoms.
With a frequency of 1.2–4.9% and affecting the RCA in 50%, coronary
artery aneurysms are usually asymptomatic and discovered by chance
during angiography3. CAA can be characterised based on
morphology or coronary artery distribution, with atherosclerosis
accounting for 50% of CAA4. Kawasaki illness is
responsible for 17% of instances that usually affects infants and
children but may emerge in adulthood5. Mycotic and
infectious septic emboli from illnesses like syphilis and borreliosis
are rarer causes, accounting for 11% of CAA. Even more unusual causes
of CAA include Marfan’s syndrome, arteritides such as polyarteritis
nodosa, Takayasu’s disease, systemic lupus erythematosus,
neurofibromatosis, primary cardiac lymphoma, and congenital
conditions5. Iatrogenic CAA has also been linked to
drug-eluting stents and balloon angioplasty6. Angina
pectoris, myocardial infarction, sudden death, fistula development,
rupture with hemopericardium or tamponade, compression of adjacent
tissues, or congestive heart failure can be the presenting condition of
a patient with CAA6. Furthermore, though extremely
rare, CAA can be misleading as para cardiac or intracardiac
masses7. For the differential diagnosis of an
aneurysm, echocardiography, coronary CTA, and magnetic resonance imaging
(MRI) are essential. Because of its superior soft-tissue contrast and
various manipulable characteristics, MRI is the most sensitive tool for
assessing tissue in the case of a tumour. Furthermore, coronary
angiography helps confirm the diagnosis of coronary artery aneurysm and
myocardial infarction, which aids the surgical
approach8.
CAA has a mixed prognosis, with a 5-year survival rate of approximately
71 percent6. The management of coronary artery
aneurysms includes medical intervention, stent insertion and surgical
resection8. For small asymptomatic coronary aneurysms,
conservative or medical therapy is preferable. To reduce the risk of
thromboembolic consequences, these patients are treated aggressively
with changes in cardiovascular risk factors, antiplatelet medication,
and anticoagulation, with 3-monthly monitoring
recommended9. Surgical intervention is required when
CAA and GCAA are causing symptoms. CABG, resection with end-to-end
anastomoses, or interposition vein graft are among the surgical options
available through a median sternotomy10. In
individuals with a high surgical risk, coil embolization and
percutaneous therapy with covered stent implantation have also been
employed as non-surgical options5.