Giant Coronary Artery Aneurysm as a Rare Cause of Premature Ventricular Contractions

Figures

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  Visual Summary. Clinical Outline of the Case With Giant Coronary Aneurysm Causing PVCs CAA = coronary artery aneurysm; PVC = premature ventricular contraction; RVOT = right ventricular outflow tract; SR = sinus rhythm.

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  Figure 1. Electrocardiograms at Initial Presentation and During Angiography (A) A 12-lead electrocardiogram demonstrating sinus rhythm with frequent PVCs suspected to originate from the left ventricular outflow tract. (B) Electrocardiogram during angiography showing frequent PVC bigeminy induced by the injection of contrast agent into the left coronary artery. PVC = premature ventricular contraction.

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  Figure 2. Computed Tomography Imaging and Angiography (A) Computed tomography imaging showing the giant CAA (red asterisk) with a maximum short diameter of 23 mm adjacent to the RVOT and LCC. (B) Coronary angiography revealing a CAA at the ostium of the LAD and a fistula between the aneurysm and the pulmonary artery. CAA = coronary artery aneurysm; LAD = left anterior descending artery; LCC = left coronary cusp; LCX = left circumflex artery; LV = left ventricle; RA = right atrium; RCA = right coronary artery; RCC = right coronary cusp; RV = right ventricle; RVOT = right ventricular outflow tract.

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  Figure 3. Intracardiac Echocardiography and Electroanatomic Mapping (A) Upper panel: Intracardiac echocardiographic imaging showing a CAA adjacent to the RVOT and LCC. Lower panel: Three-dimensional computed tomography displaying the slice corresponding to the echocardiographic image in the upper panel. (B) Electroanatomical three-dimensional mapping showing the endocardial ablation site on the LCC (pink tags) and RVOT (blue tags). Abbreviations as in Figure 2.

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  Figure 4. Intraoperative Findings (A) Intraoperative view showing a CAA adjacent to the RVOT. (B) The opening of the fistula in the main PA. (C) The fistula opening within the CAA. (D) The communication between the LAD and the CAA. (E) Cryoablation applied to the base of the aneurysm. CAA = coronary artery aneurysm; LAD = left anterior descending artery; PA = pulmonary artery; RV = right ventricle; RVOT = right ventricular outflow tract.

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  Figure 5. Postprocedure Imaging (A) Computed tomography imaging after surgical coronary aneurysmectomy. (B) Coronary angiography after the procedure. LA = left atrium; other abbreviations as in Figure 2.