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Giant coronary artery stulas are very rare case. Coronary anomalies
are seen in 1.3% of coronary angiograms with 10%13% of these
anomalies are coronary artery stulas.1 Huge coronary artery stulas
are extremely rare, and only a few case reports have been described. 2
Most coronary artery stulas are asymptomatic and are found
incidentally during coronary angiography, cardiac Computed
Tomography (CT) scan, or other imaging modalities. The course of the
disease and the management has not been clearly dened. However,
approximately 20% of these stulas are clinically relevant.1,3
The cardiac CT
result showed a
dominant right
coronary artery. The
right coronary artery and the left main coronary artery originating at
the usual site of valsava sinus. The left main origin is in the left
coronary cusp, the left main became huge and ectatic and divided into
the left anterior descending artery and the left circumflex coronary
artery. The left circumflex artery was huge and very tortuous, twisting
few times before joining and draining into the coronary sinus, which
was also dilated.
Figure 2. Cardiac CT
result
References
1. Yamanaka O and Hobbs RE. Coronary artery anomalies in
126,595 patients undergoing coronary arteriography. Cathet
Cardiovasc Diagn 1990; 21: 2840.
2. Darwazah AK, Eida M, Batrawy M, Isleem I and Hanbali. N.
Surgical treatment of circumflex coronary aneurysm with
stulous connection to coronary sinus associated with persistent
left superior vena cava. J Card Surg 2011; 26: 608612.
3. Yildiz A, Okcun B, Peker T, Arslan C, Olcay A and Bulent Vatan M.
Prevalence of coronary artery anomalies in 12,457 adult patients
who underwent coronary angiography. Clin Cardiol 2010; 33:
E60E64.
4. Hajj-Chahine J, Haddad F, El-Rassi I and Jebara V. Surgical
management of a circumflex aneurysm with stula to the
coronary sinus. Eur J Cardiothorac Surg 2009; 35: 10861088.
5. Kabbani Z, Garcia-Nielsen L, Lozano ML, Febles T,Febles-
Bethencourt L and Castro A. Coil embolizationof coronary artery
stulas. A single-centre experience. Cardiovasc Revasc Med
2008; 9: 1417.
6. Almansori, Mohammed and Tamim, Muhammed. Giant coronary
artery stula. Asian Cardiovascular and Thoracic Annal. 2013