LAUSR

Coronary artery aneurysms may present with angina, involve both the right and left coronary arteries and the leftmain trunk, and fistulize into the pulmonary artery, or present as a pericardial mass. We present the images of a giant left coronary artery aneurysm extending from the left main trunk and extending into the left anterior descending (LAD) presenting with unstable angina. A 43-year-old male with a history of hypertension and diabetes presented with unstable angina and diffuse anterior ST segment depression. A coronary angiogram revealed a giant (2.65 × 2.25 cm) coronary artery aneurysm originating from the distal left main system (Figure 1). The right coronary artery was normal. At the time of surgery, following the initiation of cardiopulmonary bypass and cardioplegic arrest, the aneurysm was visualized (Figure 2) and a longitudinal arteriotomy was performed extending from the distal left main to the proximal LAD. The excess aneurysmal tissue was excised and the artery was closed primarily with a running 7-0 prolene suture (Figure 3). The patient tolerated the procedure well, had an uncomplicated postoperative course, and was discharged on aspirin therapy. After a short-term follow-up 3 months, the patient had no complaints of angina. A postoperative angiogram showed a patent LAD and no residual aneurysm (Figure 4).