A coronary aneurysm compressing the cardiac chambers and lungs is uncommon. We present the case of such a patient. Heart murmur was first noted at the age of 10 years. When the patient was in his thirties, an angiogram revealed a 50- to 60-mm coronary aneurysm during workup for arrhythmia, but he refused surgery. No symptoms of Kawasaki disease were recorded in his history. At age 55 years, early-stage colorectal cancer was suspected, and a computed tomography scan in our hospital showed a 70mm coronary aneurysm as an incidental finding. Even at this time, the patient wanted to postpone surgery. During follow-up, dyspnea on exertion was observed at age 57 years and the symptom gradually worsened. At age 60 years, a computed tomography scan showed an enlarged giant right coronary aneurysm, measuring 22mm at the origin, 86mm ventro-caudal to the right ventricle, and 127mm dorso-caudal to the left ventricle. The scan also showed a fistula between the coronary aneurysm and the left ventricle (figure 1A–E, videos 1 and 2 of the supplementary data: AN, aneurysm; LV, left ventricle; LA, left atrium; RA, right atrium; RCA, right coronary artery; RV, right ventricle). Transthoracic echocardiography showed bidirectional flow at the fistula and transesophageal echocardiography showed that the left ventricle was compressed by the aneurysm with mild aortic regurgitation and moderate mitral regurgitation (figure 2A-D, video 3 of the supplementary data: Ao, aorta). The patient underwent surgical treatment, involving direct closure of the coronary artery fistula and resection of the right coronary aneurysm with sleeve reconstruction (figure 3). Written consent for publication was obtained from the patient.

Figure 1

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Figure 3

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