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.