Author + information
- Received June 9, 2013
- Accepted June 25, 2013
- Published online November 19, 2013.
A 79-year-old man with controlled systemic hypertension, aortic aneurysm, and remote myocardial infarction presented with chest pains. Coronary angiography (A, Online Video 1) demonstrated a dominant left circumflex artery, occluded marginal branches, and minor ectasia (arrows). He was managed with medication. The patient re-presented 3 weeks later with symptomatic new atrial fibrillation and lateral ST-segment depression on electrocardiography. Repeat angiography (B, Online Video 2) demonstrated unchanged left anterior descending disease but some progression in his proximal circumflex ectasia. His medications were adjusted. The patient presented again 2 weeks later, with further chest pain and more pronounced inferolateral ST-segment depression than previously. Angiography (C, Online Video 3) now demonstrated a large saccular aneurysm of his proximal circumflex, with an associated fistula (arrow) draining into an atrial cavity. No evidence of vasculitis or systemic sepsis was identified over this time, and atherosclerosis was considered the underlying etiology. The aneurysm/fistula was successfully treated with the use of covered intracoronary stents.
- Received June 9, 2013.
- Accepted June 25, 2013.
- 2013 American College of Cardiology Foundation