Case Report: Giant coronary artery aneurysm with cardiac compression successfully managed by surgical resection and bypass in a normolipidemic patient

Here, we report a case of a 53-year-old woman without traditional cardiovascular risk factors who presented with acute chest pain and signs of right heart compression and superior vena cava syndrome. Multimodal imaging, including computed tomography angiography, cardiac magnetic resonance, and echocardiography, revealed a giant right coronary artery aneurysm with a maximum diameter of approximately 15.6 cm, containing a large amount of intraluminal thrombus and causing compression of the right atrium, right ventricle, and superior vena cava. Serological and pathological examinations ruled out vasculitic diseases, while histopathology of the aneurysmal wall revealed fibrous hyperplasia, architectural disorganization, and hyalinization, suggesting non-atherosclerotic, non-inflammatory arterial wall degeneration with an unclear origin. The patient underwent successful aneurysm resection, thrombus evacuation, proximal and distal ligation of the right coronary artery, and concurrent distal bypass grafting using a saphenous vein graft. Postoperatively, the central venous pressure decreased significantly, the clinical symptoms resolved rapidly, and the graft remained patent at the 3-month follow-up.