Abstract
Symptoms of SVAs, such as chest pain due to acute coronary syndrome, are
caused by the compression of the coronary artery by the aneurysm. If
asymptomatic, left SVAs are often incidentally diagnosed during a close
examination for other diseases. Here, we report the surgical case of a
patient with an asymptomatic, unruptured, giant left SVA. An 82-year-old
woman with hypertension showed abnormalities on an electrocardiogram
during a regular medical examination. Coronary computed tomography
angiography revealed an aneurysm with a diameter of 50 × 48 × 45 mm
protruding from the left sinus to the extracardiac space, compressing
the left anterior descending artery. Moderate aortic regurgitation was
observed on echocardiography. Since there was no foreseen risk other
than advanced age, surgical repair was planned based on the size of the
aneurysm and extrinsic compression of the coronary arteries. Patch
repair was performed using an artificial patch as the lesion was
confined to the left sinus. The left coronary artery button was sutured
to the patch, and coronary artery bypass grafting was performed using a
saphenous vein graft. Aortic regurgitation improved after annuloplasty
with the patch and ringed fixation of the sinotubular junction using a
polytetrafluoroethylene felt strip. Thus, for the surgical repair of a
giant SVA, although aortic root replacement is often performed, if the
lesion is localized and isolated, patch repair is less invasive and
beneficial, especially in older patients.